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Fact Sheets Weight loss and wasting syndrome Summary: Weight loss can be a life-threatening complication of HIV infection. A loss of 10% (or more) of normal body weight is called “wasting syndrome.” Weight loss may be caused by many factors, and more than one type of treatment may be required.
Weight loss may be caused by: 1. malnutrition -- not eating enough food or not eating the right kinds of food. This in turn may be caused by:
2. malabsorption -- the body is not able to absorb the nutrients it needs from food because of
Weight loss that can’t be explained by infections or drug side effects or lost appetite may be caused by HIV itself. Recently some researchers have shown that weight loss is associated with higher viral load. Rivera and colleagues assessed 33 HIV-positive patients whose median viral load was 46,887 copies/ml (range: <200-510,070 copies/ml) when they were referred to a wasting clinic. All of the patients had lost a median of 10.5 kg in the 12 to 18 months before they attended the clinic. All but one patient had wasting syndrome, and 15 of the 33 patients had no hint of other illness. The researchers found that viral load levels correlated with loss of body weight, as well as with changes to body mass index. Diagnosis It is important to find out which of many possible causes are responsible for weight loss. Often there may be more than one reason for losing weight. Once the likeliest causes are identified, the most appropriate treatments can be chosen. A variety of tests may be used to diagnose the cause(s) of weight loss, including some of these
Because there are many causes of weight loss, there are different approaches to preventing it, including:
Again, because there may be may causes of weight loss, there are a variety of treatments available. Often it may best best to combine several treatments. Appetite stimulants Megace is the brand name of megestrol acetate, a synthetic version of the hormone progesterone. Megace oral solution can help increase appetite and lead to weight gain. Most of the weight gained with Megace is fat, and not the lean body mass (muscle) that is so vital to maintaining health. Marinol is the brand name of dronabinol, a synthetic version of THC, the active ingredient in marijuana. Like marijuana, Marinol stimulates appetite by giving you “the munchies”. It can also reduce nausea and vomiting. Anabolic steroids Anabolic steroids are synthetic variations of the hormone testosterone. They can help build lean body mass, but they also have a “masculinizing” effect. Women should be cautious about using these drugs because the masculinizing effect may be permanent. Growth hormone Recombinant human growth hormone (rHGH) is a synthetic version of the hormone responsible for regulating growth and development in children. rHGH can help build lean body mass with few dangerous side effects. However, the price is so high, people may prefer to use anabolics. Immune modulators The cytokine network is a part of the immune system that is not fully understood. Cytokines are chemical messengers that signal the immune system cells to do their jobs. As the body fights an illness, cytokine levels increase, and along with their beneficial effects, cytokines may produce symptoms of illness. One cytokine, called tumour necrosis factor-alpha (TNF-alpha), is associated with low-grade fevers, aches, pains, and weight loss. Drugs that lower levels of TNF-alpha have been used as treatment for weight loss. Most of these have not shown any benefit, but thalidomide has shown a trend toward weight gain. It’s not clear exactly how thalidomide works, but 100-400 mg every night has be shown to help some people gain weight. For more information about specific treatments for weight loss, please see individual fact sheets on Megace, growth hormone, anabolic steroids, dronabinol (Marinol), and thalidomide. References Canadian Pharmaceutical Association Compendium of Pharmaceuticals and Specialities. 31st edition. Ottawa: Canadian Pharmaceutical Association,1996 Cohen PT, Sande MA, Volberding PA. The AIDS Knowledge Base. 2nd edition. Toronto: Little, Brown, and Company. 1994. Isselbacher KJ, Braunwald E, Wilson JD, Martin JB, Fauci AS, Kasper DL. Harrison’s Principles of Internal Medicine. 13th edition. Toronto: McGraw-Hill, 1994. Kotler DP, Grunfeld C. Pathophysiology and treatment of the AIDS wasting syndrome. AIDS Clinical Review 1995-6;229-75. Macallan DC, Noble C, Baldwin C, et al. Energy expenditure and wasting in human immunodeficiency virus infection. New England Journal of Medicine 1995;333:83-8. Mulligan K, Tai VW, Schambelan M. Energy expenditure in human immunodeficiency virus infection. New England Journal of Medicine 1996;336(1):70-1. Rivera S, BriggsW, Qian DJ, Sattler FR. Levels of HIV RNA are quantitatively related to prior weight loss in HIV-associated wasting. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998;17(5):411-418. Tobin MA, Chow FJ, Bowmer MI, Bally GA. A Comprehensive Guide for the Care of Persons with HIV Disease: Module I. Revised edition. Mississauga: The College of Family Physicians of Canada, 1996. | |
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1998 Author(s): Maclean D | |
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Decisions about particular medical treatments should always be made in consultation with a qualified medical practitioner who is knowledgeable about HIV-related illness and the treatments in question. MORE | |