Do you have enough information about your patients' symptoms to diagnose HIV-associated wasting?

HIV-associated wasting is not always easy to diagnose. These patient profiles may help you have a more productive conversation with your patients so you can recognize this condition when you see it.

HIV-associated wasting is a serious but treatable condition. When left untreated it is linked to higher mortality and faster disease progression.1,2

In one study, weight loss of ≥ 5% in 6 months or ≥ 3% from baseline was a significant predictor of mortality.2

Consider assessing your patients for HIV-associated wasting by1:

  • Assessing patient-reported outcomes
  • Evaluating physical endurance
  • Measuring weight
  • Calculating BMI
  • Visually examining physical appearance

HIV-associated wasting can affect anyone living with HIV, including3:

HIV-infected patients with normal CD4 counts and undetectable viral loads4,5
Long-term survivors with HIV6
Patients on antiretroviral therapy with acute infection1
Newly diagnosed patients on antiretroviral therapy7

Patient Profiles*

*These profiles are hypothetical and are intended only to represent some of the possible patient presentations.

Patient 1: 42-year old Caucasian male
Patient
42-year-old Caucasian male
HIV Disease Status
HIV-positive for 12 years, well maintained and adherent to cART treatment, normal CD4 count, undetectable viral load
COMORBIDITIES
Low testosterone
Patient Presentation
5’11”, 136 lbs, BMI: 19
Reported Symptom(s)
Despite testosterone therapy, the patient mentions being “tired all the time” and feelings of “weakness” in his arms and legs. He says he has lost about 5 lbs over the last few months, but has a good appetite and has been eating “normally.”
WHAT YOU MAY BE MISSING
Even gradual, unintentional weight loss can be a sign of wasting. What have the patient’s recorded weights been at their 2 or 3 recent visits? If their BMI is low and they’re experiencing gradual weight loss in addition to reduced energy, low testosterone may not be the only underlying cause of their symptoms.
WHAT TO ASK THE PATIENT
Are any activities more difficult to perform than they have been in the past? Are your symptoms keeping you from going about your daily activities? How long can you be active for before needing to rest? Have you noticed even greater weight loss if you think back 6 months? 12 months?
NEXT STEPS
If the patient’s answers to these questions indicate that their weight loss is unintended and progressive and that their energy levels are also decreasing over time, the patient should be evaluated for HIV-associated wasting. Alternative therapies should be discussed to determine how to best treat the patient’s symptoms.
Patient
48-year-old Caucasian male
HIV Disease Status
HIV-positive for 17 years, well maintained and adherent to cART treatment, normal CD4 count, undetectable viral load
COMORBIDITIES
Gastrointestinal problems
Patient Presentation
5’8”, 121 lbs, BMI: 18.4
Reported Symptom(s)
The patient reports to have been experiencing diarrhea on and off for the past 4-6 weeks. He has not changed his medication in that time and does not report to have been running a fever.
WHAT YOU MAY BE MISSING
The HIV virus can cause chronic inflammation in the GI tract that can prevent nutrient absorption and lead to unintended weight loss. This means that diarrhea and other gastrointestinal problems could be signs that HIV-associated wasting could be occurring.8
WHAT TO ASK THE PATIENT
When was the last time you had diarrhea? How many times have you had diarrhea in the last day? Have you had a fever? Do you know if you are losing weight? Have friends, family, or coworkers noticed any changes in your weight?
NEXT STEPS
If you are able to rule out infection and disease as causes of this patient’s diarrhea, he should be evaluated for HIV-associated wasting.
Patient
25-year-old Latina female
HIV Disease Status
HIV-positive for 2 years, well maintained and adherent to cART treatment, normal CD4 count, undetectable viral load
COMORBIDITIES
None
Patient Presentation
5’2”, 103 lbs, BMI: 18.8
Reported Symptom(s)
Though this patient follows a strict nutrition and exercise regimen intended to help her maintain her weight, she has noticed that her “clothes don’t fit right” anymore. Her friends and family have also mentioned that she “looks thin.”
WHAT YOU MAY BE MISSING
Unintentional weight loss could be a sign of HIV-associated wasting.
WHAT TO ASK THE PATIENT
Have you recently lost weight without trying? Do the changes in your weight negatively affect your health and how you feel? Have you noticed any changes in your energy level? Are you able to follow your exercise regimen?
NEXT STEPS
If your patient’s answers indicate that their weight loss is unintentional and their BMI has decreased over the past 6-12 months, they should be evaluated for HIV-associated wasting.
Patient
42-year-old Caucasian male
HIV Disease Status
HIV-positive for 12 years, well maintained and adherent to cART treatment, normal CD4 count, undetectable viral load
COMORBIDITIES
Low testosterone
Patient Presentation
5’11”, 136 lbs, BMI: 19
Reported Symptom(s)
Despite testosterone therapy, the patient mentions being “tired all the time” and feelings of “weakness” in his arms and legs. He says he has lost about 5 lbs over the last few months, but has a good appetite and has been eating “normally.”
WHAT YOU MAY BE MISSING
Even gradual, unintentional weight loss can be a sign of wasting. What have the patient’s recorded weights been at their 2 or 3 recent visits? If their BMI is low and they’re experiencing gradual weight loss in addition to reduced energy, low testosterone may not be the only underlying cause of their symptoms.
WHAT TO ASK THE PATIENT
Are any activities more difficult to perform than they have been in the past? Are your symptoms keeping you from going about your daily activities? How long can you be active for before needing to rest? Have you noticed even greater weight loss if you think back 6 months? 12 months?
NEXT STEPS
If the patient’s answers to these questions indicate that their weight loss is unintended and progressive and that their energy levels are also decreasing over time, the patient should be evaluated for HIV-associated wasting. Alternative therapies should be discussed to determine how to best treat the patient’s symptoms.

Patient
48-year-old Caucasian male
HIV Disease Status
HIV-positive for 17 years, well maintained and adherent to cART treatment, normal CD4 count, undetectable viral load
COMORBIDITIES
Gastrointestinal problems
Patient Presentation
5’8”, 121 lbs, BMI: 18.4
Reported Symptom(s)
The patient reports to have been experiencing diarrhea on and off for the past 4-6 weeks. He has not changed his medication in that time and does not report to have been running a fever.
WHAT YOU MAY BE MISSING
The HIV virus can cause chronic inflammation in the GI tract that can prevent nutrient absorption and lead to unintended weight loss. This means that diarrhea and other gastrointestinal problems could be signs that HIV-associated wasting could be occurring.8
WHAT TO ASK THE PATIENT
When was the last time you had diarrhea? How many times have you had diarrhea in the last day? Have you had a fever? Do you know if you are losing weight? Have friends, family, or coworkers noticed any changes in your weight?
NEXT STEPS
If you are able to rule out infection and disease as causes of this patient’s diarrhea, he should be evaluated for HIV-associated wasting.

Patient
25-year-old Latina female
HIV Disease Status
HIV-positive for 2 years, well maintained and adherent to cART treatment, normal CD4 count, undetectable viral load
COMORBIDITIES
None
Patient Presentation
5’2”, 103 lbs, BMI: 18.8
Reported Symptom(s)
Though this patient follows a strict nutrition and exercise regimen intended to help her maintain her weight, she has noticed that her “clothes don’t fit right” anymore. Her friends and family have also mentioned that she “looks thin.”
WHAT YOU MAY BE MISSING
Unintentional weight loss could be a sign of HIV-associated wasting.
WHAT TO ASK THE PATIENT
Have you recently lost weight without trying? Do the changes in your weight negatively affect your health and how you feel? Have you noticed any changes in your energy level? Are you able to follow your exercise regimen?
NEXT STEPS
If your patient’s answers indicate that their weight loss is unintentional and their BMI has decreased over the past 6-12 months, they should be evaluated for HIV-associated wasting.

Learn more about the many factors in the body that may contribute to HIV-associated wasting.

Learn More
References:
  1. Dudgeon WD, Phillips KD, Carson JA, Brewer RB, Durstine JL, Hand GA. Counteracting muscle wasting in HIV-infected individuals. HIV Med. 2006;7(5):299-310.
  2. Mangili A, Murman DH, Zampini AM, Wanke CA. Nutrition and HIV infection: review of weight loss and wasting in the era of highly active aniretroviral therapy from the nutrition for healthy living cohort. Clin Infect Dis. 2006;42(6):836-842.
  3. Tang AM, Jacobson DL, Spiegelman D, Knox TA, Wanke C. Increasing risk of 5% or greater unintentional weight loss in a cohort of HIV-infected patients, 1995 to 2003. J Acquir Immune Defic Syndr. 2005;40(1):70-76.
  4. Chang E, Sekhar R, Patel S, Balasubramanyam A. Dysregulated energy expenditure in HIV-infected patients: a mechanistic review. Clin Infec Dis. 2007;44:1509-1517.
  5. Wasserman P, Segal-Maurer S, Wehbeh W, Rubin DS. Wasting disease, chronic immune activation, and inflammation in the HIV-infected patient. Trop Clin Nutr. 2011;26(1):14-28.
  6. Macallan DC. Wasting in HIV infection and AIDS. J Nutr. 1999;129(1S Suppl):238S-242S.
  7. Ashby J, Goldmeier D, Sadeghi-Nejad H. Hypogonadism in human immunodeficiency virus-positive men. Korean J Urol. 2014;55(1):9-16.
  8. Deeks SG, Tracy R, Douek DC. Systemic effects of inflammation on health during chronic HIV infection. Immunity. 2013;39:633-645.
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