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Lipodystrophy and WastingLipodystrophy and Wasting
           
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no eggs shells please...
Sep 18, 2002

Hi Cade.

About 8 months ago i had a high risk exposure and several weeks afterwards I shed around 10 lbs of lean muscle virtually overnight. Shortly following were: swollen neck/cheek glands, strange stool, an inside the mouth ulcer, fatigue, heightened heart rate, rashy skin, coated tongue (probably more that im not remembering at the moment). As I tried to gain the muscle back, I found despite my hard work at the gym and high protein intake, I only gained fat (and lots of it) as now my body has assumed an odd skinny/fat appearance. I was found to have epstein barr and cmv, but still 8 months later, negative on an elisa assay for HIV. In your personal opinion, would you say I should forget about the possibility of HIV infection, or should I continue testing for hiv? HIV issue aside, every doctor I've gone to has told me epstein barr and cmv can't affect body shape on their own. And certainly not as drastically as I have changed. Would you say there is something seriously wrong here? Or can I safely relax and forget about this tissue loss and just attribute all my other symptoms to ebv and cmv and forget the whole thing? (please dont walk on egg shells as every other dr has by being vague and gentle in their response)

Response from Ms. Fields-Gardner

Okay, I won't walk on egg shells. First thing: if you think you may be HIV-infected, I would recommend that you ask for a PCR test for HIV.

It sounds as though you have been following your body composition because you say that you have lost muscle and gained only fat. If you have not followed body composition through measurement, it would be hard to fully accept this assumption.

As for the body shape changes, it is worth getting them quantified and qualified. Hormonal changes that happen with long-term infection that supports a cortisol response can change the way you distribute your weight. This includes HIV but is not limited to HIV. It has been suggested that recovery of immune function and decrease in viral load may be risk factors for development of altered body weight distribution. We might speculate that perhaps there is a similar recovery issue here, even though there is no apparent HIV infection.

Shape changes caused by altered hormonal milieu come in three major forms: lean tissue wasting, subcutaneous fat wasting, and central and visceral fat accumulation. These problems have been characterized in nonHIV-infected obese persons as well. Having an idea about how much total weight you have lost and gained and where your body mass index (weight for height) falls at the moment would surely help to anticipate what you might find if you decide to have a full assessment of these changes.

Another thing that may be worth checking is your testosterone levels. If you really lost 10 pounds of lean tissue (which will usually be accompanied by around 3-20 pounds of fat tissue depending on the severity of the infection to begin with), then it is possible that your production level is low or your body may be resistant to its own testosterone and growth hormone as a result of cortisol-mediated changes. If you are hypogonadal, it would be very difficult for your work in the gym to result in the kind of lean tissue replacement and improvement that you seek.

HIV is just one of many chronic infections that a person may have. The attack on immune cells brings its own set of challenges to the maintenance of the body, but any infection will challenge your body's ability to maintain its composition and shape over time.

Good luck to you in your work on your body and health!


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