AIDS wasting

1. AIDS Wasting

AIDS wasting, also known as HIV wasting syndrome, is a condition characterized by involuntary weight loss and muscle atrophy in individuals infected with the Human Immunodeficiency Virus (HIV). This syndrome was more prevalent in the early years of the HIV/AIDS epidemic before the advent of effective antiretroviral therapy (ART). Despite advances in treatment, AIDS wasting remains a significant concern in resource-limited settings and among individuals with advanced HIV disease.

Pathophysiology

AIDS wasting is primarily caused by a combination of factors including:

• **Metabolic changes**: HIV infection can alter metabolism, leading to increased energy expenditure and decreased appetite.
• **Malabsorption**: Damage to the gastrointestinal tract by opportunistic infections can impair nutrient absorption.
• **Chronic inflammation**: Persistent immune activation and inflammation can contribute to muscle breakdown and weight loss.
• **Opportunistic infections and malignancies**: Conditions such as tuberculosis, cryptosporidiosis, and Kaposi's sarcoma can exacerbate wasting.

Clinical Presentation

Patients with AIDS wasting typically present with:

• **Involuntary weight loss**: Defined as a loss of more than 10% of body weight.
• **Muscle atrophy**: Loss of muscle mass, leading to weakness and fatigue.
• **Diarrhea**: Chronic diarrhea is common and contributes to malnutrition.
• **Fever and night sweats**: Often associated with underlying infections.

Diagnosis

Diagnosis of AIDS wasting involves:

• **Clinical assessment**: Documenting weight loss and evaluating nutritional status.
• **Laboratory tests**: Assessing for opportunistic infections and nutritional deficiencies.
• **Imaging studies**: May be used to evaluate for underlying conditions contributing to weight loss.

Management

Management of AIDS wasting includes:

• **Antiretroviral therapy (ART)**: Effective ART is crucial in controlling HIV replication and improving overall health.
• **Nutritional support**: High-calorie, high-protein diets, and nutritional supplements can help address malnutrition.
• **Appetite stimulants**: Medications such as megestrol acetate and dronabinol may be used to increase appetite.
• **Treatment of opportunistic infections**: Addressing underlying infections is essential to improve nutritional status.

Prognosis

With the introduction of ART, the prognosis for individuals with AIDS wasting has improved significantly. However, in settings where ART is not readily available, AIDS wasting remains a major cause of morbidity and mortality.

Also see

• HIV/AIDS
• Opportunistic infections in HIV
• Antiretroviral therapy
• Malnutrition