What To Know About HIV Wasting Syndrome

Human Immunodeficiency Virus (HIV) - the term sends a shiver down the spine no matter which way you look at it. Imagine being told you have contracted this virus and your days are numbered, with no hope of recovery. Okay, there’s antiretroviral therapy (ART). ART can help people with HIV live long, healthy lives.

But once the disease reaches an advanced stage, it's over. Advanced HIV patients have to deal with something called HIV wasting syndrome.

Also known as HIV-associated wasting, it is a condition in which one sees an involuntary weight loss of more than 10% of baseline body weight, accompanied by diarrhea or weakness, as well as a fever that runs for around 30 days.

This wasting is linked to disease progression and death. Losing even 5% of body weight can have the same adverse effects. This loss of weight can be attributed to the loss of both muscle and fat. It is usually seen in the last stage of HIV, when damage to the immune system has accumulated and resulted in AIDS.

There might be a number of causes that are responsible for HIV wasting syndrome.

Poor nutrient absorption

Impaired nutrient absorption in folks with HIV can happen because of opportunistic infections and the direct impact of the virus on the intestinal lining. These infections, which target people with weakened immune systems, can ruin the gut, hindering its ability to absorb essential nutrients.

Moreso, HIV itself can result in structural and functional changes in the intestines, further bringing down absorption efficiency. Diarrhoea, a common symptom in HIV-positive individuals, further exacerbates this issue by causing the loss of nutrients, calories and fluids.

Together, these factors result in malnutrition, weight loss, and overall weakened health, which makes the management of gastrointestinal symptoms important in HIV care.

Inadequate food intake

Low intake of food in individuals suffering from HIV can be caused by a number of factors, including a lack of appetite, a common symptom of the virus itself. Particular medications might make this worse by causing side effects such as nausea, taste changes, or tingling sensations around the mouth.

Moreso, depression, frequent in those suffering from chronic illness, can majorly reduce the desire to eat. Oral infections or throat infections might make ingesting food painful and result in early feelings of fullness, further reducing intake.

Low levels of energy, another symptom of HIV, can make everyday tasks like shopping for groceries or preparing meals difficult, resulting in poor nutrition.

Metabolism changes

HIV negatively impacts the ability of the body to build protein and properly digest food, which can result in loss of muscle and malnutrition over time. This virus also interrupts normal hormone levels, including thyroid and testosterone, which play important roles in regulating metabolism.

Such hormonal imbalances can further complicate the body's ability to use nutrients effectively. Hence, people with HIV require more calories than those without the condition just to maintain their weight and energy levels.

Ensuring adequate nutrition and caloric intake is important for supporting immune function, managing symptoms and improving overall quality of life in HIV care.

There are many symptoms of HIV wasting. Some of them are :-

• Terrible weakness or diarrhea

• Fever that stays for at least one month

• Fatigue

• Loss of excess of 10% of body weight

• Deterioration of lean body mass and fat mass.

Looking at an older study from 2004, HIV-associated wasting syndrome usually becomes more apparent in the later stages of the disease. In the earlier stages, it is tough to detect because weight loss in people living with HIV can happen because of a number of causes.

According to the authors of the study, when other explanations for weight loss don’t turn up, measuring body cell mass (BCM) can give you the strongest evidence of true wasting. BCM refers to the metabolically active cells in the body - those responsible for using oxygen, metabolising glucose and producing carbon dioxide.

A decline in BCM denotes a loss of these essential, functional cells, which is a characteristic of wasting and not just simple weight loss.

Clinically, doctors often look for a combination of symptoms to make a diagnosis, like an unintentional loss of more than 10% of body weight, especially if it is accompanied by chronic diarrhea or a persistent fever that lasts more than 30 days.

Early detection is important, but because the symptoms can be subtle or overlap with other conditions, healthcare providers must be thorough in evaluating all potential causes of weight loss in HIV-positive individuals.

The recommended course of treatment for HIV is antiretroviral therapy, which brings down the amount of HIV in the blood - the viral load. When the treatment brings down the viral load to undetectable levels, it usually leads to a weight increase of around 10-25% per year.

Antiretroviral treatment can slow HIV progression and put a stop to wasting. Doctors advise HIV patients to commence this treatment as soon as possible after receiving a diagnosis.

Delaying treatment will result in continued harm to the immune system, while starting treatment early can ensure someone is healthy for many years.

Nausea and vomiting medications

Such drugs look to relieve the symptoms of HIV. Some people with these conditions have also shown an interest in cannabis or particular compounds in the plant, like cannabinoids. One clinical trial looked at the value of cannabinoids for HIV wasting.

It came to the conclusion that any evidence of effectiveness is very low, and that the compounds would probably cause side effects.

Appetite stimulants

In certain cases, doctors prescribe appetite stimulants, like megestrol acetate (Megace) and dronabinol (Marinol). However, both medicines have their pitfalls.

Megace has side effects like blood clots, diabetes and bone problems. Marinol, a synthetic form of marijuana, might result in psychosis, addiction and blood pressure changes.

Reducing diarrhea

The compromised immunity of HIV leaves a person at risk of opportunistic infections that can cause diarrhea. Doctors might try treating the. However, certain ones are very difficult to eradicate.

The best form of treatment in this case is antiretroviral therapy, as this does not allow further weakening of the immune system and results in weight gain.

Hormone treatments

The Food and Drug Administration has green-lighted the human growth hormone somatropin (Serostim) to boost weight and lean body mass. Sadly, though, this medicine is expensive and can cause major side effects.

Some experts believe that lower than FDA-approved dosages might be preferred and yet effective. Researchers are looking at other hormone treatments, like testosterone and muscle-building agents, like 19-nortestosterone (Nandrolone)

Exercise

Progressive resistance training is a kind of workout that depends on weights and machines to augment lean muscle mass. Exercise also has benefits like strengthening bones, boosting cholesterol levels and elevating mood.

Diet

Eating the right foods definitely helps. The ideal diet might differ from the low-fat, low-calorie diet that doctors usually recommend for people who are healthy. HIV patients require more protein and calories than the standard recommended quantities to put a stop to muscle loss.

Foods that can be added to the diet include

• Peanut butter

• Cheese

• Milkshakes

• Peas and beans

• Eggs

• Instant breakfast drinks

• Sauces.

In conclusion, doctors define HIV wasting syndrome as an unintended loss of weight of more than 10% of body weight, together with fever and weakness, or diarrhea that lasts for more than 30 days. This condition causes a lot of HIV associated problems with appetite, digestion and absorption.

The cure is antiretroviral therapy, which brings down the HIV viral load and can result in weight gain. Moreso, doctors might prescribe other medications for specific causes. They might also recommend including further sources of protein in the diet.

Wasting can result in a loss of muscle strength and impair quality of life, because of the resultant physical limitations.

What is HIV Wasting Syndrome?

HIV Wasting Syndrome, also called HIV-associated wasting, is a condition characterised by the unintentional loss of excess of 10% of body weight, often coupled with chronic diarrhea, weakness, or a fever that lasts in excess of 30 days.

It usually happens in the advanced stages of HIV, once the immune system is completely compromised.

What causes HIV Wasting Syndrome?

Wasting can be the result of different factors, like poor nutrient absorption thanks to infections or damage to the gut, lowered food intake from appetite loss, side effects of medications, depression or oral/throat infections, and metabolic changes that the virus causes, disrupting protein synthesis and hormone levels.

How is HIV Wasting Syndrome diagnosed?

Doctors evaluate signs like unintentional weight loss, a constant fever and chronic diarrhea. When other causes of weight loss are excluded, Body Cell Mass (BCM) measurements can proffer vital evidence of true wasting, as they indicate loss of metabolically active cells.

How is HIV Wasting Syndrome treated?

Antiretroviral therapy is the way to go - it brings down viral load and helps the immune system recover. Other treatments could include appetite stimulants, hormone therapy, nausea or diarrhea medications and nutritional support, including high-calorie, high-protein diets.

Can lifestyle changes help manage HIV Wasting Syndrome?

Yes, if you make certain lifestyle changes it can definitely help with HIV wasting syndrome. For starters, exercise, especially resistance training can help rebuild muscle mass.

A diet rich in nutrients with calorific and protein-dense foods such as eggs, milkshakes and peanut butter can help with weight gain. Managing mental health and asking for help can also improve appetite and overall well-being.