HIV wasting syndrome (HIV WS) is characterized by a minimum of 10 percent weight loss which is accompanied by severe diarrhea, chronic weakness and fever lasting for more than three to four weeks and which can only be accounted for by the human immunodeficiency virus (HIV) infection [1]. The weight loss in HIV patients can be acute due to infections or can be gradual due to malabsorption. In HIV WS, the loss of weight is due to a decrease in fat as well as lean body mass irrespective of whether the patient is on treatment with anti-retroviral medications, viral loads, and T-cell counts [2].

Initially, the patient's weight loss is not noticed as wasting although the patient's body composition has begun to change with the patient manifesting clinical features of malnutrition e.g. increase in the extracellular mass to body composition monitoring (BCM) ratio [3]. Failure to exercise may lead to loss of muscle mass in the early stages of HIV infection but its cause in the penultimate stages is still unknown. In HIV patients with diabetes, the protein and muscle mass loss may be even more severe.

Clinically, HIV WS manifests differently amongst men compared to women infected with HIV. In men with HIV WS, there is asthenia with a gradually progressive loss of weight, diminished metabolism and fat sparing versus an excessive decrease in lean body mass (LBM). On the other hand, women have an excessive decrease in body fat compared to LBM and lose more muscle mass in the late stages of the disease [4].

Patients with HIV WS may have concomitant myopathies such as polymyositis or polyarteritis nodosa (PAN) which can confuse the clinical picture. In addition, antiretroviral treatment with zidovudine can also cause myopathy which does not improve even after cessation of the medication [5].

• Weight Loss

  While ART is known to improve weight loss and malnutrition in people living with HIV, it may not necessarily prevent the loss of muscle mass or replace it once body weight is restored. [verywellhealth.com]

  The decrease in fat and lean body mass are responsible for the weight loss. [symptoma.com]

  The mechanism of weight loss in AIDS has not been clearly elucidated. [karger.com]

  Cachexia, also known as weight loss syndrome, is a common problem in patients with human immunodeficiency virus (HIV). Weight loss syndrome is defined as a loss of at least 10% of the body weight. [ikm.mk]

  loss: A person may lose weight despite getting adequate nutrition or a high number of calories. [medicalnewstoday.com]

• Chronic Diarrhea

  HIV Wasting Syndrome: Involuntary weight loss of greater than 10 percent associated with intermittent or constant fever and chronic diarrhea or fatigue for more than 30 days in the absence of a defined cause other than HIV infection. [findexpertmd.com]

  In the event of persistent or chronic diarrhea, clinical and diagnostic investigation is recommended to identify possible causes. [verywellhealth.com]

  Involuntary weight loss of greater than 10 percent associated with intermittent or constant fever and chronic diarrhea or fatigue for more than 30 days in the absence of a defined cause other than HIV infection. [expertscape.com]

  AIDS wasting syndrome: The involuntary weight loss of 10% of baseline body weight plus either chronic diarrhea (two loose stools per day for more than 30 days) or chronic weakness and documented fever (for 30 days or more, intermittent or constant) in [medicinenet.com]

  Defined as profound involuntary weight loss of greater than 10% of baseline body weight, plus either chronic diarrhea (at least two loose stools per day for more than 30 days) or chronic weakness and documented fever (for more than 30 days, intermittent [medical-dictionary.thefreedictionary.com]

• Failure to Thrive

  Preliminary information indicates that lean body mass is lost in preference to fat mass in HIV-infected children, supporting the theory that failure to thrive in HIV infection is often cytokine mediated. [clinicaltrials.gov]

  […] to thrive Slim disease B22.7 HIV disease resulting in multiple diseases classified elsewhere Note: For use of this category, reference should be made to the morbidity or mortality coding rules and guidelines in Volume 2. [apps.who.int]

  It is also detected in children with a “failure to thrive” syndrome, meaning that their current rate of weight gain is lower than in most children of the same age. The weight loss in any case is not intentional. [citiva.com]

  […] to thrive, cachexia, effects of hunger, adult neglect (nutritional), BMI <19, adult 6873 (16.1) B. [journals.lww.com]

• Food Intolerance

  […] eating is not pleasurable; and can give patients techniques for managing HIV- or medication-related symptoms such as anorexia, early satiety, nausea, vomiting, diarrhea, food intolerances, and oral or esophageal ulcers. [hivinsite.ucsf.edu]

• Muscular Atrophy

  It is a type of chronic muscular atrophy and in CKD, it is associated with PEW, limiting the independence of the patient and their quality of life. It compromises vital organs, with respiratory, musculoskeletal and heart muscle deterioration 18. [revistanefrologia.com]

The workup of HIV WS should be able to identify the condition and exclude other causes of weight loss such as malnutrition, malabsorption, and infections in patients with HIV. It is also important to differentiate it from HIV-lipodystrophy, and hyperlactatemia which can occur with nucleoside analog reverse transcriptase inhibitor (NRTI) therapy [6]. Besides history and physical examination, the workup should include nutritional assessment, serial measurements of weight in standardized conditions [7] to detect and monitor wasting; body mass index (BMI) measurement, weight trends to monitor the patient's nutritional status, bioimpedance analysis over a period of time to evaluate LBM, total body water and fat using regression analysis [8] and sequential anthropometry (mid arm circumference, triceps skinfold thickness) to predict prognosis [9].

An endocrine evaluation to exclude hypogonadism as the cause of wasting and gastrointestinal referral to look for malabsorption are also a vital part of the workup.

Dual-energy X-ray absorptiometry (DEXA), magnetic resonance imaging (MRI), and computed tomography (CT) can provide more accurate information about body composition but are expensive tests and therefore are only being used currently for research purposes.

Food and Drug Administration in 2012 for the treatment of diarrhea in people with HIV. [verywellhealth.com]

The dosage for treatment of weight loss depends on tolerability, from 1 x 2.5 mg /day to 2 x 10 mg /day. [ikm.mk]

Successful treatment calls for identification of possible etiologies of wasting in the individual patient with AIDS. Further treatment may include treating underlying conditions and controlling such symptoms as diarrhea, nausea, or fever. [ncbi.nlm.nih.gov]

Review HIV-related cachexia: potential mechanisms and treatment J H Von Roenn et al. Oncology. 1992. [pubmed.ncbi.nlm.nih.gov]

[…] to monitor the patient's nutritional status, bioimpedance analysis over a period of time to evaluate LBM, total body water and fat using regression analysis and sequential anthropometry (mid arm circumference, triceps skinfold thickness) to predict prognosis [symptoma.com]

Prognosis Overall, the prognosis for the cachexia depends upon the severity of the underlying disease. [ 20 ] Prevention [ 15 ] Exercise is being explored as a possible preventative measure against cancer cachexia. [patient.info]

What is the prognosis? With good diet and medication, weight and muscle mass can be maintained. However, wasting remains a common cause of death among Aids patients. Complications Treatments often has as a result a build-up of fat, not muscle. [health24.com]

In cancer patients, cachexia is associated with a decreased response to therapy and a poor prognosis. In all patients, cachexia causes a dramatic loss of skeletal muscle, leading to immobility. [citiva.com]

AIDS Transmission AIDS Treatment AIDS Prognosis History of AIDS AIDS Stigma [news-medical.net]

The relative contributions of each of these etiologies to wasting probably varies considerably from patient to patient. Successful treatment calls for identification of possible etiologies of wasting in the individual patient with AIDS. [ncbi.nlm.nih.gov]

Applicable To Wasting syndrome Code First Code First Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10data.com]

A variety of etiologies, which vary among patients, contributes to this syndrome. (From Harrison's Principles of Internal Medicine, 13th ed, p1611). [findexpertmd.com]

97 Allowable Qualifiers English : BL blood CF cerebrospinal fluid CI chemically induced CL classification CO complications CN congenital DI diagnosis DG diagnostic imaging DH diet therapy DT drug therapy EC economics EM embryology EN enzymology EP epidemiology [decs.bvs.br]

Balkanov, Marija Darkovska Serafimovska, PHARMACOTHERAPY APPROACH IN KIDNEY CANCER THERAPY, KNOWLEDGE - International Journal : Vol. 38 No. 4 (2020): Knowledge without borders Milka Zdravkovska, Bisera Stojmenova – Runteva, Marija Darkovska-Serafimovska, EPIDEMIOLOGICAL [ikm.mk]

This is what is known as the reverse or paradoxical epidemiology uraemic obesity phenomenon. [revistanefrologia.com]

With thorough and competent searching, a specific causative agent can usually be found for wasting syndrome because it is essentially a classical exclusion diagnosis and really more of an epidemiological instrument than a specific disease. [hivbook.com]

OBJECTIVE: To review the pathophysiology and treatment of HIV wasting syndrome. DATA SOURCES AND STUDY SELECTION: MEDLINE searches (January 1987-September 1997) of the English-language medical literature were conducted. [ncbi.nlm.nih.gov]

PATHOPHYSIOLOGY With respect to pathophysiology, two issues need to be addressed: the mechanism of salt wasting and the mechanism of hyponatremia. The mechanism by which cerebral disease might lead to renal salt wasting is poorly understood. [uptodate.com]

Protéine recombinante SIDA Somatotropine Somatropine Traitement Virus immunodéficience humaine Hormone adénohypophysaire Hormone neurohypophysaire Immunodéficit Immunopathologie Infection Lentivirus Retroviridae Virose Virus Keyword (en) Cachexia Human Pathophysiology [pascal-francis.inist.fr]

Cancer cachexia and its pathophysiology: links with sarcopenia, anorexia and asthenia. Peixoto da Silva S, Santos JMO, Costa E Silva MP, Gil da Costa RM, Medeiros R. Peixoto da Silva S, et al. [pubmed.ncbi.nlm.nih.gov]

Pathophysiology The causes of cachexia and anorexia are only now beginning to be elucidated. [clinicalcorrelations.org]

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/nchhstp/Default.htm. Updated March 7, 2013. Accessed June 3, 2013. [cancercarewny.com]

While ART is known to improve weight loss and malnutrition in people living with HIV, it may not necessarily prevent the loss of muscle mass or replace it once body weight is restored. [verywellhealth.com]

However, the best way to prevent cachexia is to reduce the risk of underlying conditions. [medicalnewstoday.com]

Brown, M.D., Coordinator, Microbicides and Women and Girls Research, Office of AIDS Research, National Institutes of Health Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention staff All material contained on these pages are free [womenshealth.gov]

In addition, more detailed information about the mechanisms of wasting has the potential to generate new approaches for early detection, prevention, and treatment. [journals.lww.com]

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8. Kotler DP, Burastero S, Wang J, Pierson RN Jr. Prediction of body cell mass, fat-free mass, and total body water with bioelectrical impedance analysis: effects of race, sex, and disease. Am J Clin Nutr. 1996 Sep;64(3 Suppl):489S-497S.
9. Heymsfield SB, McManus C, Smith J, Stevens V, Nixon DW. Anthropometric measurement of muscle mass: revised equations for calculating bone-free arm muscle area. Am J Clin Nutr. 1982 Oct;36(4):680-90.