Fact Sheet Number 518
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PrintAIDS wasting is the involuntary loss of more than 10% of body
weight, plus more than 30 days of either diarrhea, or weakness
and fever. Wasting is linked to disease progression and death.
Losing just 5% of body weight can have the same negative effects.
Wasting is still a problem for people with AIDS.
Part of the weight lost during wasting is fat. More important
is the loss of muscle mass. This is also called “lean body
mass”, or “body cell mass.” Lean body mass can
be measured by bioelectrical impedance analysis (BIA.) This is
a simple, painless office procedure.
AIDS wasting and lipodystrophy both can cause some body shape
changes. See Fact Sheet 553 for
more information on lipodystrophy. Wasting is the loss of
muscle. Lipodystrophy is a loss of fat. They are not the same
thing. However, wasting in women can start with a loss of fat.
WASTING?
Several factors contribute to AIDS wasting syndrome.
- Low food intake: Low appetite is common with HIV.
Also, some AIDS drugs have to be taken with an empty stomach,
or with a meal. This can make it difficult for some people with
AIDS to eat when they’re hungry. Drug side effects such as nausea,
changes in the sense of taste, or tingling around the mouth also
decrease appetite. Opportunistic infections in the mouth or throat
can make it painful to eat. Infections in the gut can make people
feel full after eating just a little food. Finally, lack of money
or energy may make it difficult to shop for food or prepare meals.
- Poor nutrient absorption: Healthy people absorb nutrients
through the small intestine. In people with HIV disease, several
infections (including parasites) interfere with this process.
HIV may directly affect the intestinal lining and reduce nutrient
absorption. Diarrhea, a frequent side effect of AIDS drugs, causes
loss of calories and nutrients.
- Altered metabolism: Food processing and protein building
are affected by HIV disease. Even before any symptoms show up,
energy output is increased. This might be caused by the increased
activity of the immune system. People with HIV need more calories
just to maintain their body weight.
Hormone levels can affect the metabolism. HIV seems to change
some hormone levels. Also, cytokines play a role in wasting. Cytokines
are proteins that produce inflammation to help the body fight
infections. People with HIV have very high levels of cytokines.
This makes the body produce more fats and sugars, but less protein.
Unfortunately, these factors can work together to create a
“downward spiral”. For example, infections may increase
the body’s energy requirements. At the same time, they can interfere
with nutrient absorption and cause fatigue. This can reduce appetite
and make people less able to shop for or cook their meals. They
eat less, which accelerates the process.
TREATED?
There is no standard treatment for AIDS Wasting. Treatments for
wasting syndrome address each of the causes mentioned above.
- Low food intake: Reducing nausea and vomiting can
increase food intake. Also, appetite stimulants including Megace®
and Marinol® have been used. Megace, unfortunately, is associated
with increases in body fat. Marinol is sometimes used to increase
appetite. It is a synthetic form of a substance found in marijuana.
AIDS activists have long urged the legalization of marijuana.
It reduces nausea and stimulates the appetite. In the late 1990s,
several states legalized the medical use of marijuana. See Fact Sheet 731 for more information
on marijuana.
- Poor nutrient absorption: Absorption can be improved
by treating diarrhea and opportunistic infections in the gut.
There has been a lot of progress in this area. However, two parasitic
infections – cryptosporidiosis
and microsporidiosis – are still extremely difficult to treat.
Another approach is nutritional supplements like Ensure®
and Advera®. These have been specifically designed to provide
easy-to-absorb nutrients. They have not been carefully studied
yet.
- Altered metabolism: Hormone treatments are being examined.
Human growth hormone increases weight and lean body mass, while
decreasing fat mass. However, it is extremely expensive and could
cost over $40,000 per year to use. Testosterone and anabolic
(muscle building) steroids might also help treat wasting. They
are being studied alone and in combination with exercise. Also,
thalidomide seems to reverse weight loss due to its ability to
reduce levels of cytokines.
AIDS wasting is not well understood. However, it is clear that
people with HIV disease need to avoid the loss of lean body mass.
Various treatments for wasting are being studied.
Be sure to monitor your weight. Maintain your intake of nutritious
foods even if your appetite is low. Get treatment right away for
serious diarrhea or any infection of your digestive system. These
might cause problems with the absorption of nutrients.
Revised November 26, 2002
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New Mexico AIDS Education and Training Center
and the New Mexico Department of Health