Wasting

Wasting is the unintended loss of more than 10% of a personÕs body weight, usually after 30 days of diarrhea or weakness and fever.

Wasting should not be mistaken for facial wasting (lipoatrophy). Facial wasting is the loss of fat under the skin. It makes the face look thinner or gaunt. It is not a sign that HIV infection or AIDS is progressing. Wasting is. When wasting occurs, there is a loss of both ft and muscle. 

Symptoms

Signs of wasting are:

• 30 days or more of either diarrhea or weakness and fever
• Unintended loss of more than 10% of a person's body weight
• Loss of both fat and muscle
• Noticeable thinning of the face, arms and legs

Causes

Several factors cause wasting, including:

• Not eating enough. HIV-infection can cause a loss of appetite. Some drugs used to treat AIDS cause nausea, odd sensations in the mouth such as tingling and changes in the sense of taste, all of which can make a person not want to eat. Mouth or throat infections such as thrush can make it painful to eat. Infections of the gut may make people feel full after eating only a little food. Lack of money or energy may make shopping or preparing food hard.
• Not being able to absorb nutrients well. The nutrients needed for good health are absorbed through the small intestine. People with HIV infection may get parasites or opportunistic infections that interfere with the process of digesting food. Diarrhea, a side effect of AIDS drugs, can cause a loss of calories and nutrients.
• Altered metabolism. HIV affects how food is processed and used in the body. People with HIV need more calories just to maintain their body weight. This may be a result of the increased activity of the immune system.
• Changes in hormone levels. HIV changes some hormone levels. This, in turn, can affect how the body digests and uses food.
• High cytokines levels. Cytokines are proteins that produce inflammation to fight infections. People with HIV have high cytokine levels. This makes the body produce more fats and sugars, but less protein.

When two or more of these are at work, the wasting grows worse.

Prevention

Persons with HIV infection should monitor their weight. They should make sure to eat enough nutritious food Ð even when they donÕt feel like it. They should get treatment right away for serious diarrhea or any infection of the digestive system.

Diagnosis

A doctor will do an examination and get the patientÕs medical history. The doctor may order a CD4 count. (Symptoms of wasting usually begin to appear when the CD4 count falls below 350.)

Treatment

Treatment should be tailored to the situation each patient faces. There is no standard approach. Options include:

• Reducing nausea and vomiting
• Stimulating the appetite. Drugs such as Megace and Marinol help increase appetite.
• Treating diarrhea and infections in the intestine
• Nutritional substitutes. There are products that have been designed for people who are at risk of not getting enough nutrients. They are designed to provide easy-to-absorb nutrients in a convenient to buy and use form.
• Training with weights helps the body build up muscle. Some studies have shown that using small weights is as effective as oxandrolone (an anabolic steroid) in increasing muscle mass.