Your patients may experience HIV-associated wasting even when their HIV virus is well controlled on antiretroviral treatments1

HIV-associated wasting is a serious disease that affects many different patients, including those with undetectable viral loads and normal CD4 counts.1,2


Your patients may experience HIV-associated wasting even when their HIV virus is well controlled on antiretroviral treatments1

HIV-associated wasting is a serious disease that affects many different patients, including those with undetectable viral loads and normal CD4 counts.1,2

Over time, as patients lose weight, physical endurance may be lost3-13

HIV-associated wasting is characterized by abnormalities in the way the body uses carbohydrates, fats, and proteins to meet energy and tissue-building needs. As patients lose weight unintentionally, they also lose lean body mass (LBM), which can be associated with a decline in strength and functional performance.

HIV-associated wasting has been associated with negative outcomes for patients7

  • Impaired functional status
  • Accelerated disease progression

HIV-associated wasting can be a concern across a range of patients1,14-16

  • Newly diagnosed patients
    • Among those with advanced HIV disease, one-third will present with wasting
  • Poor virologic responders
  • Patients on antiretroviral therapy who fail to gain weight
  • HIV Long-Term Survivors
  • Patients on antiretroviral therapy with acute infection
  • HIV-positive patients with normal CD4 counts and controlled viral loads
  • Those who have not been adherent to antiretroviral treatment

Your patients may experience HIV-associated wasting even when their virus is well controlled on antiretroviral treatments.

Many factors contribute to the pathophysiology of unintentional weight loss4,7,17

HIV-associated wasting is a diagnosis of exclusion. There are several factors associated with reduced caloric intake or altered metabolism that may be important in triggering unintentional weight loss in your patients living with HIV.



  • Proinflammatory cytokines have numerous effects throughout the body, including inducing the acute-phase response (APR)
  • APR is part of the early-defense or innate immune system, which is triggered by stimuli such as trauma, infection, stress, neoplasia, and inflammation
  • In patients with HIV, APR becomes chronic, leading to the continuing breakdown of muscle, which can lead to unintentional weight loss
  • Even with a controlled HIV infection, a sustained inflammatory state may persist indefinitely
  • A sustained inflammatory state contributes to multimorbidity and mortality
  • Even in patients with undetectable viral loads, the gut-associated lymphoid tissue (GALT) can serve as a reservoir of the HIV virus
  • This stimulates chronic inflammation and immune activation
  • HIV alters the gut flora and can lead to long-term effects on epithelial barrier and T-cell function in the gut
  • Over time, integrity of protective mucosal barrier is diminished
  • Disruptions are associated with inflammation and malabsorption of vital nutrients
  • Dysregulation of cellular pathways can lead to weight loss, inappropriate depletion of LBM, and preservation of body fat
  • A number of factors may promote excessive catabolic activity
    • Proinflammatory cytokines
    • Hormonal imbalances
    • Elevated resting energy expenditure
    • Stress
    • Increased cortisol levels
  • Changes affecting other cellular pathways, such as the phosphoinositide-3-kinase (PI3K) pathway, may also contribute to HIV-associated wasting
  • Characterized by disruption of the hormonal regulatory axes and abnormal levels of hormones, such as
    • Glucagon
    • Insulin
    • Epinephrine
    • Glucocorticoids, such as cortisol
  • These hormones regulate metabolism of proteins, lipids, and carbohydrates
  • Reduced serum IGF-1 levels may lead to increased protein degradation and loss of LBM
  • Shift in endocrine function towards increased levels of the catabolic hormone cortisol may contribute to wasting
  • Acquired GH resistance may result in decreased production of IGF-1 by the liver
  • Disruptions in the GH/IGF-1 axis can lead to elevated serum GH levels and reduced serum IGF-1 levels
  • Other factors may contribute to HIV-associated wasting
    • Diarrhea
    • Infections
    • Low testosterone

Asking your patients the right questions about their symptoms may help you identify HIV-associated wasting and intervene early

Ask your patients:

  • 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?
  • Do you have a loss of energy?
  • Do you frequently feel tired during daily activities, such as walking up stairs?
  • Are any activities more difficult to perform?
  • Do you need to rest more often?
  • Are you exercising less?

Consider measuring weight, calculating BMI, and reviewing a weight history*
of your patient to help screen for HIV-associated wasting.

For additional guidance on speaking with your patients about this condition,
download the Physician-Patient Dialogue Guide.
DOWNLOAD DIALOGUE GUIDE*A weight history should include a premorbid or prediagnosis weight, as well as weight trends over time.

Show References

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  2. Mangili A, Murman DH, Zampini AM, Wanke CA. Nutrition and HIV infection: review of weight loss and wasting in the era of highly active antiretroviral therapy from the nutrition in healthy living cohort. Clin Infec Dis. 2006;42(6):836-842.
  3. Dudgeon WD, Phillips KD, Carson JA, Brewer JA, Durstine JL, Hand GA. Counteracting muscle wasting in HIV-infected individuals. HIV Med. 2006;7(5):299-310.
  4. Gelato M, McNurlan M, Freedland E. Role of recombinant human growth hormone and HIV-associated wasting and cachexia: pathophysiology and rationale for treatment. Clin Ther. 2007;29(11):2269-2288.
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  8. Roubenoff R, Grinspoon S, Skolnik PR, et al. Role of cytokines and testosterone in regulating lean body mass and resting energy expenditure in HIV-infected men. Am J Physiol Endocrinol Metab. 2002;283(1):E138-E145.
  9. Perry CM, Wagstaff AJ. Recombinant mammalian cell-derived somatropin. A review of its pharmacological properties and therapeutic potential in the management of wasting associated with HIV infection. Biodrugs. 1997;8(5):394-414.
  10. Grace JM, Semple SJ, Combrink S. Exercise therapy for human immunodeficiency virus/AIDS patients: guidelines for clinical exercise therapists. J Exer Sci Fit. 2015;13(1):49-56.
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  13. Wilson D, Hurtado RM, Digumarthy S. Case 18-2009: a 24-year-old woman with AIDS and tuberculosis with progressive cough, dyspnea, and wasting. N Engl J Med. 2009;360:2456-2464.
  14. Falutz J. Growth hormone and HIV infection: contribution to disease manifestations and clinical implications. Best Pract Res Cl En. 2011;25:517-529. 1998. Accessed August 30, 2018.
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