Diagnosis

Unintentional weight loss with or without an identifiable cause could signal HIV-associated wasting (HIVAW), even in people with undetectable HIV^1,2

Timely identification and treatment of HIVAW is important to help restore health and potentially reduce mortality risk³

WHY ASSESS

Patients with HIVAW may face additional risks

HIVAW is a serious but treatable condition. When left untreated, it is linked to more hospitalizations and emergency room visits, faster disease progression, and higher mortality.^4-6

People with HIVAW experience

more annual hospitalizations

more emergency department visits

vs people without HIVAW⁴

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

Continuous assessment and timely diagnosis of HIVAW can^3,4:

Prevent further weight loss

Prevent functional decline

Reduce morbidity and mortality

HOW TO ASSESS

Continuous assessment may help with timely identification

In contrast to the pre-ART era, HIVAW may also occur among PWH who are virologically suppressed.¹

HIV-associated weight loss (HAWL) is an updated, clinically relevant, proposed definition for HIVAW in the modern era of ART⁷
HIVAW had varying clinical presentations over the decades due to the ability to manage and control viral load with ARTs⁸
HAWL is intended to account for changes in phenotypes of HIVAW that have occurred with improvements in ART and viral control⁸

It’s important to assess your patients at each visit for HIVAW or HAWL by:

Measuring weight

Visually examining physical appearance

Calculating BMI

Evaluating physical endurance

Assessing patient-reported outcomes

WHO TO ASSESS

HIVAW should be top of mind for all types of PWH

HIVAW can affect anyone living with HIV, including those who:

are newly diagnosed⁹
are long-term survivors¹⁰
have their virus well-controlled on ART^11,12
are on ART and are losing weight without trying⁹

are on ART and have, or have had, an HIV/AIDS-related infection¹¹
are living with advanced HIV disease⁹
are on ART, but whose viral load has not gone down¹¹
have been prescribed ART, but are not taking it as directed¹¹

Assessing for HIVAW should be a priority, especially if unintentional weight loss persists and comorbid conditions or other causes of unintentional weight loss have been addressed.

Talk to your patients about any concerns they may have about unintentional weight loss or low energy.

Download this list of questions to help start the dialogue.

DOWNLOAD QUESTIONS

PATIENT PROFILES

See how HIVAW may manifest differently in different patients

HIVAW 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.

Meet Sam

Despite being eugonadal on testosterone replacement therapy, the patient mentions being “tired all the time” and feelings of “weakness” in his arms and legs…

Patient

42-year-old Black 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 Symptoms

Despite being eugonadal on testosterone replacement 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 Patients Like Sam

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 HIVAW. Alternative therapies should be discussed to determine how to best treat the patient's symptoms.

Meet Doug

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…

Patient Profile 2

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

Chronic diarrhea

Patient Presentation

5'8”, 121 lbs, BMI: 18.4

Reported Symptoms

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 virus can cause chronic inflammation in the gastrointestinal (GI) tract that can prevent nutrient absorption and lead to unintended weight loss. This means that diarrhea and other GI problems, including malabsorption disorders, could be signs that HIVAW could be occurring.

What to Ask Patients Like Doug

How long have you had diarrhea?
How many times a day/week do you have diarrhea?
Have you had a fever?
Have you noticed you are losing weight without trying?
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 HIVAW.

Meet Maria

Though this patient follows a strict nutrition and exercise regimen intended to help her maintain her weight, she noticed that her “clothes don’t fit right” anymore…

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, no reported amenorrhea

Comorbidities

Hypothyroidism, adequately treated with Synthroid, TSH and T4 WNL

Patient Presentation

5'2”, 103 lbs, BMI: 18.8

Reported Symptoms

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 HIVAW.

What to Ask Patients Like Maria

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 HIVAW.

The causes of HIVAW are complicated and multifactorial. Learn more about the pathogenesis of this syndrome.

See the current treatment options available for HIVAW.

The people depicted on this website are not actual healthcare providers or patients with HIV-associated wasting.

References: 1. Mounzer K, Brunet L, Hsu R, et al. Changes in body mass index associated with antiretroviral regimen switch among treatment-experienced, virologically suppressed people living with HIV in the United States. AIDS Res and Human Retroviruses. 2021;37(11)852-861. 2. Siddiqui J, Samuel S, Hayward B, et al. HIV-associated wasting prevalence in the era of modern antiretroviral therapy. AIDS. 2022;36:127-135. 3. Wohlfeiler MB, Weber RP, Brunet L, et al. Incident HIV-associated wasting/low eight is associated with nearly doubled mortality risk in the modern ART era. AIDS Res Hum Retroviruses. 2024; doi.org/10.1089/AID.2023.0113 4. Siddiqui J, Samuel S, Hayward B, et al. The economic burden of HIV-associated wasting in the era of modern antiretroviral therapy. J Manag Care Spec Pharm. 2022;20(10):1180-1189. 5. 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. 6. 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. 7. Siddiqui J, Phillips AL, Freedland ES, Sklar AR, Darkow T, Harley CR. Prevalence and cost of HIV-associated weight loss in a managed care population. Curr Med Res Opin. 2009;25(5):1307-1317. 8. Wanke C, Kotler D, and the HIV Wasting Collaborative Consensus Committee. Collaborative recommendations: the approach to diagnosis and treatment of HIV wasting. J Acquir Immune Defic Syndr. 2004;37(5):S284-S288. 9. Falutz J. Growth hormone and HIV infection: contribution to disease manifestations and clinical implications. Best Pract Res Clin Endocrinol Metab. 2011;25(3):517-529. 10. Wasserman P, Segal-Maurer S, Wehbeh W, Rubin DS. Wasting disease, chronic immune activation, and inflammation in the HIV-infected patient. Top Clin Nutr. 2011;26(1):14-28. 11. Macallan DC. Wasting in HIV infection and AIDS. J Nutr. 1999;129(1S suppl):238S-242S. 12. Erlandson KM et al. Long-term impact of HIV wasting on physical function. AIDS. 2016;30(3):445-454.

PUTTING CONTINUOUS ASSESSMENT AND TIMELY DIAGNOSIS OF HIVAW INTO PRACTICE

Unintentional weight loss with or without an identifiable cause could signal HIV-associated wasting (HIVAW), even in people with undetectable HIV1,2

WHY ASSESS

Patients with HIVAW may face additional risks

People with HIVAW experience

vs people without HIVAW4

Continuous assessment and timely diagnosis of HIVAW can3,4:

HOW TO ASSESS

Continuous assessment may help with timely identification

It’s important to assess your patients at each visit for HIVAW or HAWL by:

WHO TO ASSESS

HIVAW should be top of mind for all types of PWH

Talk to your patients about any concerns they may have about unintentional weight loss or low energy.

PATIENT PROFILES

See how HIVAW may manifest differently in different patients

Meet Sam

Meet Sam

Patient

HIV Disease Status

Comorbidities

Patient Presentation

Reported Symptoms

What You May Be Missing

What to Ask Patients Like Sam

Next Steps

Meet Doug

Meet Doug

Patient

HIV Disease Status

Comorbidities

Patient Presentation

Reported Symptoms

What You May Be Missing

What to Ask Patients Like Doug

Next Steps

Meet Maria

Meet Maria

Patient

HIV Disease Status

Comorbidities

Patient Presentation

Reported Symptoms

What You May Be Missing

What to Ask Patients Like Maria

Next Steps

Learn more about a specific treatment option for HIV-associated wasting

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The following site is intended for US healthcare professionals only.

PUTTING CONTINUOUS ASSESSMENT AND TIMELY DIAGNOSIS OF HIVAW
INTO PRACTICE

Unintentional weight loss with or without an identifiable cause could signal HIV-associated wasting (HIVAW), even in people with undetectable HIV^1,2

vs people without HIVAW⁴

Continuous assessment and timely diagnosis of HIVAW can^3,4: