Hello: I have been HIV postive as of 1994. My T-cell is 920 and my viral load is 500. The last year I have lost weight. My doctor has checked my absorpion and it is okay. They are not sure why I have been losing weight. I just got done with a year long divorce that was stressful. I eat three times a day and my calorie intake is very high. I like to eat but seem not to gain weight. Besides my weight I feel great. I'm 6'2" and now holding about 165-168. I would like to be about 185 or 190 as I was in 1995. My doctor tells me it is not the HIV as my t-cell and viral load are okay. I smoke a pack a day. So what do I need to do to put on 20 pounds? Should I stop smoking, would this help. Is there anything I can take to help beside growth hormones. Should I go to see someone for this besides my HIV doctor. It there any other test I should have done.

You have given several clues about what may be happening and it is worth checking out further. If intestinal absorption is adequate (by the way, what kind of test did they do?), then there may be other factors in play. Here is what I would suggest:

1. Get your calorie intake checked. This is easily done by writing down what you eat over several days (include amount and how it was prepared for each food item for better evaluation) and have a dietitian run the numbers.

2. Yes, smoking will change how well your food intake is used to gain and maintain weight. So, if you are thinking about quitting smoking, go for it! Not only will quitting smoking remove that roadblock to gaining weight, but it will also reduce your risk of other chronic diseases that complicate treated HIV infection (such as heart disease, bone loss, and others). Your lungs may be better equipped to withstand and reduce lung infections that contribute to weight loss, as well.

3. You may want to add an HIV-specialist dietitian to your team and see about a physical therapy consult to add an exercise component to your plans in gaining weight in the best possible way.

Good luck on this endeavor!