The pathogenesis of HIV-associated wasting is multifactorial1

Contributing factors have been identified across a number of physiological systems1

Pathogenesis of Wasting

Gastrointestinal issues, endocrine abnormalities, immune dysregulation, and metabolic changes may all play a role in HIV-associated wasting. Go inside the body to learn more about why HIV-associated wasting may occur.1,2

Gastrointestinal Changes

Even in HIV patients with undetectable viral loads, the gut-associated lymphoid tissue, or GALT, remains a latent reservoir for the virus. This leads to changes in the structure and function of the gut that may contribute to HIV-associated wasting. Learn more about how these various changes can impact a patient's ability to maintain weight, energy, and lean body mass.2-5

Endocrine Dysfunction

HIV-associated wasting has been attributed in part to endocrine dysfunction. Disruptions of the hormonal regulatory axes together with abnormal hormone levels lead to problems regulating the metabolism of proteins, lipids, and carbohydrates which can lead to weight loss, loss of energy, and loss of lean body mass. Explore how these issues, in addition to other endocrine system dysfunctions, may cause symptoms of HIV-associated wasting.2,6

Immune Dysregulation

Both the innate and adaptive immune systems can become dysfunctional in response to HIV infection. Even when the virus is controlled, latently infected cells remain. Dysregulation of cytokine production is a key immunological abnormality associated with HIV-associated wasting.2,7,8

Metabolic Changes

Multiple factors, such as elevated resting energy expenditure, hormonal imbalance, elevated proinflammatory cytokines, and stress, may promote a shift in metabolism towards excessive catabolic activity. In this catabolic state, the body is shifted to breaking down proteins and other molecules instead of being in equilibrium. This dysregulation can lead to weight loss and an inappropriate depletion of lean body mass.2,9,10

Explore the treatment landscape and the options for addressing HIV-associated wasting in your patients

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References:
  1. 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.
  2. 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.
  3. Koethe JR, Heimburger DC, PrayGod G, Filteau S. From wasting to obesity: the contribution of nutritional status to immune activation in HIV infection. J Infec Dis. 2016;214(Suppl 2):S75-S82.
  4. Dandekar S. Pathogenesis of HIV in the gastrointestinal tract. Curr HIV Aids Rep. 2007;4(1):10-15.
  5. Márquez M, Fernández Gutiérrez del Álamo C, Girón-González JA. Gut epithelial barrier dysfunction in human immunodeficiency cirus-hepatitis C virus coinfected patients: influence on innate and acquired immunity. World J Gastroenterol. 2016;22(4):1433-1448.
  6. de Pee S, Semba RD. Role of nutrition in HIV infection: review of evidence for more effective programming in resource-limited settings. Food Nutr Bull. 2010;31(4):S313-S344.
  7. Chereshnev VA, Bocharov G, Bazhan S, et al. Pathogenesis and treatment of HIV infection: the cellular, the immune system and the neuroendocrine systems perspective. Int Rev Immunol. 2013;32(3):282-306.
  8. Atfeld M, Gale M. Innate immunity against HIV-1 infection. Nature Immunol. 2015;16(6):554-562.
  9. Gelato M, McNurlan M, Freedland E. Role of recombinant human growth hormone in HIV-associated wasting and cachexia: pathophysiology and rationale for treatment. Clin Ther. 2007;29(11):2269-2288.
  10. Cohen S, Nathan JA, Goldberg AL. Muscle wasting in disease: molecular mechanisms and promising therapies. Natur Rev. 2015;14:58-74
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