My husband was diagnosed 8 years ago. He has never had any problems and he did not take any medication. About 4 years ago he began to slowly lose weight and now he is having all types of problems. He's lost lots of weight and muscle. He does not have a sex drive. He is breaking out in rashes. What in the world should we do. He looks like he is about to die. Please help.

During four years of losing weight, I hope that you have had the opportunity to visit a dietitian. There is usually a "findable" reason why someone loses weight and the answer lies in finding the cause.

Most commonly, appetite is lost and food intake is reduced which leads to weight loss. After about 10% of weight is lost there are some hormonal changes that occur, one of which is an inadequate production of testosterone. Testosterone is essential to the maintenance of muscle tissues and sex drive.

Head back to the doctor right away and talk about dealing with the weight issue. As many other patients know, a low viral load and a great CD4 count can mean very little when you are wasting away.

Ask for a referral to a dietitian who has experience in HIV care. Dietitians do this stuff for a living... it is their specialty. Have your husband fully evaluated to figure out which problems are contributing to weight loss and associated changes in the body. Get the diet evaluated and listen to recommendations to determine which will work best for your husband. And, follow-up routinely with the dietitian to work on refining and adjusting where it is needed.

In addition to diet, you will want your husband's doctor to discuss medical problems that can contribute to weight loss and its associated problems and work out a medical plan that complements the efforts in diet and physical activity.

Because so much time has gone by, your husband's body has probably been working to adapt to a less-than-optimal situation and, as a result, he may have lost some function. It may be an intensive bit of work, especially in the beginning, to get the weight back and to reverse other problems associated with weight loss. It is well worth the effort and your effort should start today!

Best wishes in the work ahead!