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Fact Sheet
Wasting Syndrome

May 21, 2012


What Is AIDS Wasting?

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AIDS 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. Although the incidence of wasting syndrome has decreased dramatically since 1996, wasting is still a problem for people with AIDS, even people whose HIV is controlled by medications.

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) or by a full body x-ray (DEXA) scan. These are simple, painless office procedures.

AIDS wasting and lipoatrophy can both cause some body shape changes. See Fact Sheet 553 for more information on lipodystrophy. Wasting is the loss of weight and muscle. Lipoatrophy can cause a loss of fat under the skin. Wasting is not the same as fat loss caused by lipodystrophy. However, wasting in women can start with a loss of fat.


What Causes AIDS Wasting?

Several factors contribute to AIDS wasting:

Hormone levels can affect the metabolism. HIV seems to change some hormone levels including testosterone and thyroid. 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.


How Is Wasting Treated?

There is no standard treatment for AIDS wasting. However, successful antiretroviral treatment usually leads to healthy weight gain. Treatments for wasting deal with each of the causes mentioned above.

Decreasing viral load to undetectable levels usually leads to increased weight (average 10-25% increase in a year).

Testosterone and anabolic (muscle building) agents like oxandrolone or nandrolone might also help treat wasting. They have been studied in HIV by themselves and in combination with exercise.

Progressive resistance training (PRT) is a form of exercise using weights and machines. A recent study found that PRT gave similar results to oxandrolone (an anabolic steroid) in increasing lean body mass. PRT was also more effective than oxandrolone in increasing physical functioning. It is also less expensive. Exercise can also improve mood and cholesterol, and can strengthen bone. See Fact Sheet 802 for more information on exercise and HIV.


The Bottom Line

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.




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