When patients lose weight unintentionally, they also lose lean body mass, which can be associated with a decline in strength and functional performance. HIV-associated wasting is characterized by abnormalities in the way the body uses carbohydrates, fats, and proteins to meet energy and tissue-building needs.
Patients with HIV could have unintentional weight loss and decreased physical endurance, including:
- Newly diagnosed patients on antiretroviral therapy14
- Long-term survivors with HIV12,15
- HIV-infected patients with normal CD4 counts and undetectable viral loads15,16
- Patients on antiretroviral therapy with acute infection6,15
HIV-associated wasting is a diagnosis of exclusion, and the underlying condition and comorbidities should be addressed individually as appropriate. The following are factors associated with reduced caloric intake or altered metabolism that may be important in triggering unintentional weight loss in your patients living with HIV:
- Excess of proinflammatory cytokines18,19,23
- These proinflammatory cytokines have numerous effects throughout the body, including inducing the acute-phase response (APR)
- The APR is part of the early-defense or innate immune system, which is triggered by different stimuli, including trauma, infection, stress, neoplasia, and inflammation
- In patients with HIV infection, the APR becomes chronic
- In healthy individuals, the body replaces skeletal muscle rapidly as it recovers. In contrast, in patients with HIV infection, the acute-phase response may become chronic with continuing breakdown of muscle, which can lead to unintentional weight loss
- Even when HIV infection is controlled with antiretroviral therapy, a sustained inflammatory state may persist indefinitely. This contributes to multi morbidity and mortality
- Growth hormone (GH) resistance2,21,22
- Acquired GH resistance may result in decreased production of IGF-1 by the liver
- In patients with HIV infection, disruptions in the GH/IGF-1 axis can lead to elevated serum GH levels and reduced serum IGF-1 levels
- Difficulty swallowing
- Loss of appetite
- Low testosterone
- Metabolic changes
- Recreational drug use
Questions to engage them may include:
Do you have a loss of physical endurance associated with unintentional weight loss?
- Are any activities more difficult to perform?
- Are you exercising less?
- Do you need to rest more often?
- Do you frequently feel tired after certain activities?
Have you had unintentional weight loss?
- Have you recently lost weight without trying?
- Do any changes in your weight negatively affect your health and how you feel?
- Do your clothes fit more loosely than normal due to unintentional weight loss?
- Have friends, family, or coworkers noticed any changes in the way that you look based on changes in your weight?
In addition to speaking with your patients, other ways that can help you screen for unintentional weight loss include measuring weight, calculating BMI, and reviewing a weight history.15