HIV – Associated

FOR HEALTHCARE PROVIDERS

DO YOU HAVE ENOUGH INFORMATION ABOUT YOUR PATIENTS’ SYMPTOMS TO DIAGNOSE HIV-ASSOCIATED WASTING?

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 at each visit for HIV-associated wasting by:

Measuring Weight

Visually Examining Physical Appearance

Calculating BMI

Evaluating Physical Endurance

Assessing Patient-Reported Outcomes

Patient types

HIV-associated wasting can affect anyone living with HIV, including those who:
  • are newly diagnosed3
  • are a long-term survivors4
  • have their virus well-controlled on ART5,6
  • are on ART and are losing weight without trying3
  • are on ART and have, or have had, an HIV/AIDS-related infection5
  • are living with advanced HIV disease3
  • are on ART, but your viral load has not gone down5
  • have been prescribed ART, but are not taking it as directed5

Download a list of questions you can ask to engage your patients in a dialogue about their unintentional weight loss.

DOWNLOAD QUESTIONS

Patient profiles*

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.

Patient Profile 1

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

Read more about Patient Profile 1

Patient Profile 2

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…

Read more about Patient Profile 2

Patient Profile 3

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…

Read more about Patient Profile 3
Patient Profile 1

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 SYMPTOM(S)

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 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 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 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 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, including malabsorption disorders, could be signs that HIV-associated wasting could be occurring.

 

WHAT TO ASK THE PATIENT

  • 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 HIV-associated wasting.

Patient Profile 3

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 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.

The causes of HIV-associated wasting are complicated and multifactorial. Learn more about the pathogenesis of this syndrome.

READ CAUSES

See the current treatment options available for HIV-associated wasting.

SEE TREATMENTS

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

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

DISCOVER A TREATMENT OPTION

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. 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.
  3. 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.
  4. Macallan DC. Wasting in HIV infection and AIDS. J Nutr. 1999;129(1S suppl):238S-242S.
  5. 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.
  6. Erlandson KM et al. Long-term impact of HIV wasting on physical function. AIDS. 2016;30(3):445-454.