HIV-associated wasting affects people even when their HIV virus is well controlled on antiretroviral therapy1,2

If left untreated, HIV-associated wasting can have serious consequences.3
Learn more about starting a conversation with your doctor below.

What are some of the symptoms of HIV-associated wasting?

There are three key elements of HIV-associated wasting:

1
Weight Loss
HIV-associated wasting causes people to lose weight when they aren’t trying to. Their clothes may fit more loosely, and friends, family, and coworkers may comment that they look different.3
2
Decreased Energy
Some people with HIV-associated wasting get tired more quickly than they used to and find they can no longer do the things they love to do.3
3
Loss of Lean Body Mass (LBM)
LBM includes muscles, organs, blood, bone, and water. People living with HIV have changes in the way the body builds and breaks down LBM. Losing LBM leads to decreased energy and physical endurance.3,4

Who gets HIV-associated wasting?

There isn’t just one type of person who experiences HIV-associated wasting. This condition affects a variety of people living with HIV, including:

  • Those who have lived with HIV for a long time5
  • HIV-positive people who have undetectable viral loads and normal CD4 counts6,7
  • People taking HIV medication who have had an acute infection, such as pneumonia3
  • HIV-positive people with normal appetites and unchanged energy expenditure8
  • Newly diagnosed people on HIV medications9

It’s important to treat HIV-associated wasting as soon as possible— so don’t wait to speak with a doctor3

HIV-associated wasting is linked to poor physical function, faster disease progression, and even an increased risk of death. Only a healthcare professional can diagnose HIV-associated wasting. Ask your doctor the following questions to get the conversation started3:

“I have less energy than I used to have. Could this be a sign of HIV-associated wasting?”
“My family has noticed changes in my weight and in the way I look. How can I know for sure if I have HIV-associated wasting?”
“I have lost weight recently without trying. Could I have HIV-associated wasting?”
“The changes in my weight negatively affect my health and how I feel. Do I have HIV-associated wasting?”

These are hypothetical questions you could ask your doctor. They are based on real patient experiences but are not actual patient quotes.

What can cause HIV-associated wasting?

The exact cause of HIV-associated wasting isn’t known, but experts believe it can be caused by one or more of the following1:

Changes in metabolism
  • Metabolism is how the body turns food into energy10
  • When metabolism becomes abnormal, the body may break down carbohydrates and proteins at an excessive rate3,4,11
  • If this happens, energy is drawn from lean body mass, which means a loss of muscle, organ tissue, blood cells, bone, and water3,4,11
  • The gastrointestinal system absorbs nutrients, electrolytes, and water into the body12
  • Layers in the intestinal wall defend against toxins and microorganisms that may harm the body12
  • The HIV virus may disrupt this system, leading to changes in how nutrients are absorbed and the rate at which the body breaks down proteins3,4,12
  • When the body doesn't absorb enough nutrients or breaks down proteins too quickly, loss of weight and lean body mass may occur3,4,12
  • There are several causes of diarrhea, including13,14
    • Bacterial and viral infections
    • Irritable bowel syndrome
    • Intestinal disease
    • Food intolerances
    • Reactions to medications
  • Diarrhea may result in abdominal pain, dehydration, and weight loss3
  • GH is made up of several substances secreted by the pituitary gland that support growth of the body
  • GH helps maintain bone and skeletal muscle in the body3
  • GH resistance is a failure to process and respond to GH that occurs naturally in the body3
  • When the body resists or has difficulty using GH the body makes naturally, or if the body is not making enough GH, a loss of lean body mass may occur3,11
  • The testicles in males and, to a lesser extent, the ovaries in females produce the hormone testosterone15
  • Testosterone helps with maintaining muscle mass, bone growth, adequate red blood cell levels, and sexual function15
  • Low levels of testosterone may lead to a significant loss of lean body mass, as well as a reduction in the ability to exercise16
  • Infections may cause changes in metabolism and increase the body’s caloric needs7
  • The need for increased energy coupled with decreased nutrient intake may result in unintentional weight loss and energy loss6,17
  • Due to their compromised immune systems, people living with HIV may be at a greater risk for infection. cART (combination antiretroviral therapy) is unable to restore the immune system or resolve the infection18
  • Inflammation is a natural response to infection, stress, trauma, or cell injury in the body19
  • Even when the HIV virus is controlled, inflammation may continue to occur20
  • Chronic inflammation can cause the breakdown of muscle tissue and decreased appetite, leading to weight loss and loss of lean body mass11,20

A healthy diet and exercise are key parts of treatment

The right balance of good nutrition, exercise, and lifestyle choices is important for maintaining overall health. View the short videos below to get some quick nutrition and exercise tips. These tips are not a substitute for your doctor's expertise. Talk to your doctor about how to develop the best nutrition and exercise plan for you.

Exercises To Try

Staying Healthy With HIV

Choose My Plate Information

Recommended Diet & Lifestyle Changes

7 Tips for Good Sleep

There are many treatment options to help with one or more symptoms of HIV-associated wasting. Talk to your doctor about your options and click below to learn more about a specific treatment for this condition.

Learn More
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. 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. 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.
  4. Demling R. The use of anabolic agents in catabolic states. J Burns Wounds. 2007;6:33-49.
  5. Macallan DC. Wasting in HIV infection and AIDS. J Nutr. 1999;129(1S Suppl):238S-242S.
  6. 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.
  7. 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.
  8. Kotler D. Challenges to diagnosis of HIV-associated wasting. J Acquir Immune Defic Syndr. 2004;37:S280-283.
  9. Ashby J, Goldmeier D, Sadeghi-Nejad H. Hypogonadism in human immunodeficiency virus-positive men. Korean J Urol. 2014;55(1):9-16.
  10. Medical Dictionary. Metabolism. Medical Dictionary. https://medical-dictionary.thefreedictionary.com/Metabolism. Accessed August 24, 2018.
  11. 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.
  12. 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.
  13. MacArthur RD, DuPont HL. Etiology and pharmacologic management of noninfectious diarrhea in HIV-infected individuals in the highly activate antiretroviral therapy era. Clin Infec Dis. 2012;55(6):860-867.
  14. National Institute of Diabetes and Digestive and Kidney Issues. Symptoms & Causes of Diarrhea. National Institutes of Health. https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea/symptoms-causes. Accessed July 11, 2018.
  15. Medical Dictionary. Testosterone. Medical Dictionary. https://medical-dictionary.thefreedictionary.com/testosterone. Accessed August 24, 2018.
  16. Grinspoon S, Corcoran C, Lee K, et al. Loss of lean body and muscle mass correlates with androgen levels in hypogonadal men with acquired immunodeficiency syndrome and wasting. J Clin Endocrinol Metab. 1996;81(11):4051-4058.
  17. Grinspoon S, Mulligan K. Weight loss and wasting in patients infected with human immunodeficiency virus. Clin Infec Dis. 2003;36(Suppl 2):S69-S78.
  18. Wilson EMP, Sereti I. Immune restoration after antiretroviral therapy: the pitfalls of hasty or incomplete repairs. Immunol Rev. 2013;254(1):343-354.
  19. Medical Dictionary. Inflammation. Medical Dictionary. https://medical-dictionary.thefreedictionary.com/Inflammation. Accessed August 24, 2018.
  20. 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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