HIV wasting syndrome is a rare condition defined by a loss of weight by at least 10 percent accompanied by diarrhea, chronic weakness and documented fevers lasting for up to a month which can only be accounted for by the human immunodeficiency virus infection. The decrease in fat and lean body mass are responsible for the weight loss.
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 . 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 .
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 . 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 .
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 .
Entire Body System
- Weight Loss
The decrease in fat and lean body mass are responsible for the weight loss. [symptoma.com]
Selection of the appropriate agent(s) depends on the underlying cause for weight loss, adverse effects, and cost of therapy. [ncbi.nlm.nih.gov]
However, loss of lean muscle tissue and the loss of overall body weight are closely correlated. [journalce.powerpak.com]
Wasting ( cachexia ) should not be confused with weight loss, the latter of which implies the loss of body weight. By contrast, wasting refers to the loss of body size and mass, most notably lean muscle mass. [aids.about.com]
Wasting syndrome refers to unwanted weight loss of more than 10 percent of a person's body weight, with either diarrhea or weakness and fever that have lasted at least 30 days. For a 150-pound man, this means a weight loss of 15 pounds or more. [hiv.va.gov]
- Weight Gain
For these three patients, weight gain was potentially due to the recognized weight gain associated with the initiation of zidovudine. For the remaining 18 patients, however, appetite stimulation and weight gain were a result of megestrol acetate. [pubmed.ncbi.nlm.nih.gov]
Thalidomide therapy has been proven effective at inducing weight gain in those with HIV-associated wasting, but only one small study showed weight gain in cancer patients (11). [clinicalcorrelations.org]
Others will present with weight gain primarily composed of body fat with no associated gain in muscle, while still others will experience weight gain and an increase in BCM.10 This may be related in part to nonpharmacologic considerations, such as diet [journalce.powerpak.com]
Cannabis was associated with little or no weight gain in observational studies, but with weight gain in a few higher-quality studies (clinical trials). [examine.com]
And nearly every one of them showed that marijuana (THC) can increase appetite and weight gain in cachectic patients. [medicalmarijuana.eu]
- Intravenous Drugs
Use intravenous drugs. People who use intravenous drugs often share needles and syringes. This exposes them to droplets of other people's blood. Are an uncircumcised man. [mayoclinic.org]
Rates are even higher in intravenous drug users (Campa 2005). Weight loss remains an independent risk factor for mortality, even in the HAART era, and every patient should be weighed regularly. [hivbook.com]
Intravenous drug users should be counseled on the risks of sharing intravenous drug paraphernalia. For patient education information, see the Immune System Center and Sexually Transmitted Diseases Center, as well as HIV/AIDS and Rapid Oral HIV Test. [emedicine.medscape.com]
- Surgical Procedure
If the surgeon inserts an implant, which is the wrong shape or a preformed shape versus customized, then it will not give the correct appearance after the surgical procedure. [facechange.org]
Fat transfer Transferring your own subcutaneous fat from one part of your body to another through a surgical procedure. A higher upfront cost than with temporary synthetic injectable fillers. [poz.com]
- Chronic Diarrhea
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
[…] 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]
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]
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]
Clinical course of patients enrolled as outpatients. aOne case of suspected miliary TB, one case of suspected TB meningitis. bOne case of confirmed TB meningitis (rifampicin resistant on Xpert MTB/RIF assay). cTwo cases of suspected TB meningitis, one [bmcmedicine.biomedcentral.com]
Cryptococcal meningitis. Meningitis is an inflammation of the membranes and fluid surrounding your brain and spinal cord (meninges). [mayoclinic.org]
Oster JR, Perez GO, Larios O, Emery WE, Bourgoignie JJ: Cerebral salt wasting in a man with carcinomatous meningitis. Arch Intern Med 1983;143:2187–2188. [karger.com]
Cryptococcal meningitis is the most common form of meningitis in patients with AIDS, typically causing symptoms that mimic other disorders such as headache, irritability, and nausea. Most patients have a CD4 cell count of less than 100/uL. [journalofethics.ama-assn.org]
It can quickly spread to the brain, often leading to cryptococcal meningitis. Left untreated, this fungal infection is often fatal. Cryptosporidiosis. This diarrheal disease often becomes chronic. [healthline.com]
Clinical findings of PML include clumsiness, progressive weakness, and visual and speech changes. Personality and cognitive changes may also occur. [ssa.gov]
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 . Besides history and physical examination, the workup should include nutritional assessment, serial measurements of weight in standardized conditions  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  and sequential anthropometry (mid arm circumference, triceps skinfold thickness) to predict prognosis .
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.
- Mycobacterium Avium Complex
Wasting can happen rapidly, especially during particular opportunistic infections such as mycobacterium avium complex (MAC), tuberculosis, or pneumocystis pneumonia (PCP). More gradual wasting can also occur, sometimes due to the HI virus itself. [health24.com]
avium complex (MAC) infection Many others Research has found that many of the conditions mentioned above can be associated not only with disordered eating but also eating disorders, such as anorexia nervosa. [acute.org]
Mycobacterium avium C omplex Infection. Disseminated Mycobacterium avium (MAI) complex infection is common in patients with advanced-stage HIV infection and a CD4 cell count of less than 50/uL. [journalofethics.ama-assn.org]
Mycobacterium avium complex. This is a type of bacterial infection. It often presents in people with severely compromised immune systems (CD4 cell counts of less than 50). If these bacteria enter the bloodstream, it often results in death. [healthline.com]
Opportunistic infections commonly associated with wasting syndrome include disseminated Mycobacterium avium complex infection, cytomegalovirus infection and Pneumocystis carinii pneumonia. [aafp.org]
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]
Related: Access to treatment, All topics, Opportunistic infections, Starting treatment. Is there any hope at this stage with very low CD4 levels..lower than 10? Answer Answer: Charlotte Walker Thank you for your question. [i-base.info]
Wasting Syndrome Treatment Besides the regular treatment for HIV infection, treating the symptoms of wasting is the only way to control the physical deterioration due to viral infection. Reduced calorie intake results in loss of appetite. [ayushveda.com]
[…] 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]
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]
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]
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]
A variety of etiologies, which vary among patients, contributes to this syndrome. (From Harrison's Principles of Internal Medicine, 13th ed, p1611). [decs.bvs.br]
A variety of etiologies, which vary among patients, contributes to this syndrome. (From Harrison's Principles of Internal Medicine, 13th ed, p1611). Show Experts Show Synonyms Graphical View Show Experts Show Articles [expertscape.com]
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]
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]
This is what is known as the reverse or paradoxical epidemiology uraemic obesity phenomenon. [revistanefrologia.com]
Zdravkovska, Irena Eftimovska Rogac, Nadica Bozhinovska, JEJUNAL ADENOCARCINOMA: A CASE REPORT, KNOWLEDGE - International Journal : Vol. 31 No. 4 (2019): The teacher of the future Milka Zdravkovska, Bisera Stojmenova – Runteva, Marija Darkovska-Serafimovska, EPIDEMIOLOGICAL [ikm.mk]
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]
The pathophysiology of wasting syndrome is multifactorial. [journalce.powerpak.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]
Pathophysiology The causes of cachexia and anorexia are only now beginning to be elucidated. [clinicalcorrelations.org]
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]
Connect, share, and collaborate with other prevention professionals. [npin.cdc.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]
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]
[…] by health departments that provide information on the critical role of SSPs in prevention and treatment. [aids.gov]
- Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. Council of State and Territorial Epidemiologists; AIDS Program, Center for Infectious Diseases. MMWR Morb Mortal Wkly Rep. 1987 Aug 14;36 Suppl 1:1S-15S.
- Mulligan K, Schambelan M. HIV-associated wasting. 2003 Nov. http://hivinsite.ucsf.edu/InSite?page=kb-04-01-08#S1X Accessed 3/3/2017
- Bell SJ, Bistrian BR, Connolly CA, et al. Body composition changes in patients with human immunodeficiency virus infection. Nutrition. 1997;13:629-632
- Grinspoon S, Corcoran C, Miller K, et al. Body composition and endocrine function in women with acquired immunodeficiency syndrome wasting. J Clin Endocrinol Metab. 1997;82:1332-1337.
- Miro O, Pedrol E, Cebrian M, et al. Skeletal muscle studies in patients with HIV-related wasting syndrome. J Neurol Sci. 1997;150:153-159.
- Carr A, Miller J, Law M, Cooper DA. A syndrome of lipoatrophy, lactic acidaemia and liver dysfunction associated with HIV nucleoside analogue therapy: contribution to protease inhibitor-related lipodystrophy syndrome. AIDS. 2000 Feb 18;14(3):F25-32.
- Grunfeld C, Feingold KR. Body weight as essential data in the management of patients with human immunodeficiency virus infection and the acquired immunodeficiency syndrome. Am J Clin Nutr. 1993 Sep;58(3):317-8.
- 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.
- 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.