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Wasting

Wasting syndrome is characterized by weight loss of at least 10% for at least 30 days that is not attributable to a concurrent condition other than HIV infection itself. Weight loss has a negative impact on survival and disease progression in AIDS. The prevalence of wasting has declined significantly since the introduction of protease inhibitors.

Clinical evaluation of wasting

Body mass index (BMI; weight in kg divided by height in square meters) is a

Malabsorption should be excluded as a cause of weight loss because this disorder can occur in the absence of diarrhea. Hypogonadism may be present in men with wasting; therefore, serum testosterone levels should be

Free testosterone levels are more accurate than total testosterone levels.

Dietary assessment should include a diet history, estimation of current energy intake, and identification of factors that might interfere with food intake. Quantitative estimation of daily intake of energy should be obtained, using

Treatment of wasting syndrome

Treatment of underlying disorders, such as oral or esophageal candidiasis, aphthous ulcers, chronic diarrhea or malabsorption and depression, may result in

Target energy intakes are 33 to 44 kcal/kg in men and 29 to 44 kcal/kg in women. Protein intake of 1.5 g/kg, a daily multivitamin and a mineral supplement should be

Oral nutritional supplementation can usually increase net daily energy intake. Liquid and solid oral supplements are

Enteral and parenteral feeding. Repletion or maintenance of weight by enteral or parenteral routes may be considered in individuals who are unable to meet nutritional goals with

Pharmacologic treatments

Megestrol acetate ( Megace) is a synthetic progestational agent that may increase food intake and weight; however, weight gain usually consists of fat. Patients treated with 800 mg of megestrol acetate per day for

Dronabinol ( Marinol)

Dronabinol is the synthetic form of tetrahydrocannabinol, the active ingredient in marijuana. Dronabinol consistently improves appetite, but

Recombinant human growth hormone (rhGH) is effective in producing weight gain and retention of nitrogen and potassium. Side effects included arthralgias, myalgia, puffiness, and diarrhea. It is approved for

Anabolic steroids

Testosterone replacement in hypogonadal men increases weight. Testosterone enanthate or cypionate is administered by intramuscular injection (200-400 mg IM 1-2 times per month). Two transdermal preparations are

Oxandrolone ( Oxandrin) is an oral testosterone derivative that is approved as a treatment for weight loss. A dosage of 5 to 20 mg/day may provide a

Oxymetholone ( Anadrol-50), 1 to 2 mg/kg/day, an oral agent, produced a mean weight gain of 5.7 kg and improvements in Karnofsky score in patients with

Thalidomide. In patients with HIV-associated wasting, thalidomide (100 mg four times daily for 12 weeks) produced a median weight gain of 4.05 kg. Patients treated with 100 mg nightly for 8 weeks experienced a 4% increase in Because of teratogenic effects in infants, women of childbearing potential must be advised to use at least two methods of contraception while using thalidomide.

Exercise. Inactivity is associated with significant loss of muscle mass. Progressive resistance training may increase upper and lower body strength and weight. Combinations of aerobic and resistance training in individuals with HIV infection results in