Challenges to Diagnosis of HIV-Associated Wasting
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Abstract:
There is a wide variability in the clinical presentation of the protein energy malnutrition often characterized as wasting in patients infected with HIV. Moreover, the clinical presentation has evolved over time. Initially, protein energy malnutrition was characterized by profound weight loss and depletion of body cell mass (BCM). Recently, unrelated concurrent metabolic abnormalities, such as lipodystrophy, may complicate the diagnosis of HIV wasting. Although measures of BCM are relatively accurate for the diagnosis of HIV wasting, the optimal tools for assessing BCM are not necessarily available to the clinician. From the practical standpoint, HIV wasting may be a self-evident diagnosis in advanced stages, but effective interpretation of the early signs of HIV wasting requires familiarity with other complications included in the differential diagnosis.Keywords:
Wasting Syndrome
Lipodystrophy
Mass wasting
Presentation (obstetrics)
Lipodystrophy
Wasting Syndrome
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Cachexia, weight loss, and muscular wasting are characteristics of advanced infection with the human immunodeficiency virus (HIV). Death usually occurs when 20% of total body weight is lost. Usually, when an individual develops this syndrome, commonly known as AIDS wasting, it is a poor prognostic sign for survival. The impact of modern treatments for AIDS infections with antiretroviral drugs and protease inhibitors has had a positive impact to increase long-term survival with the disease. AIDS wasting is now becoming much less common The pathogenesis of AIDS wasting involves poor appetite, inefficient use of caloric intake because of intercurrent diseases, medication-induced gastrointestinal problems (nausea, vomiting, and diarrhea), and the effect of HIV infection itself on muscle and tissue breakdown (1,2).
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Hypermetabolism
Wasting Syndrome
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Purpose of review Cachexia is a progressive deterioration of body habitus associated with certain chronic diseases (e.g., cancer, chronic obstructive pulmonary disease, chronic heart failure, and chronic kidney disease). The aim of this article is to describe the prevalence and impact of cachexia (and precachexia) in such patients. Recent findings Owing to the wide spectrum of clinical presentation and lack of an 'all-inclusive' definition, it is difficult to estimate the true prevalence of cachexia. Perhaps 2% of the population suffer from precachexia (characterized by weight loss in association with a chronic disease). The significant increase in obesity of the general population (which can mask significant muscle wasting) confounds such simple estimates of the true prevalence of cachexia. In contrast, a multidimensional characterization of the cachectic state (including weight loss, reduced food intake, and systemic inflammation) may be more meaningful in terms of altered clinical outcomes. Such a multidimensional view of cachexia has been shown to impact on patients' survival and quality of life and therefore constitutes a major public health issue. Summary There is a high prevalence of (pre)cachexia in patients with chronic diseases. The cachexia syndrome is probably less frequent but has a significant impact in terms of morbidity and mortality.
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Pathophysiology
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This article highlights pre-clinical and clinical studies into the field of wasting disorders that were presented at the 8th Cachexia Conference held in Paris, France December 2015. This year some interesting results of clinical trials and different new therapeutic targets were shown. This article presents the biological and clinical significance of different markers and new drugs for the treatment of skeletal muscle wasting. Effective treatments of cachexia and wasting disorders are urgently needed in order to improve the patients' quality of life and their survival.
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Lipodystrophy
Anorexia
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Highly active antiretroviral therapy in HIV‐1 infected patients is associated with a lipodystrophy syndrome, characterized by wasting of peripheral fat, central adiposity, hyperlipidaemia and insulin resistance. The CT findings are presented and the differential diagnosis is discussed.
Lipodystrophy
Wasting Syndrome
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Weight loss is a negative prognostic indicator in patients infected with HIV. Mortality rates rise measurably with as little as 3-5% weight loss over 6 months. The sensitivity of this measure is at least partly due to the correlation between weight loss and a metabolic cachexia that has been observed with other infections, trauma, and some cancers. However, the cachexia in patients with HIV, commonly termed wasting, may also be due to, or exacerbated by, reduced caloric intake, gastrointestinal dysfunction, or metabolic abnormalities independent of abnormal energy expenditure. In patients with HIV wasting, therapies should be directed both at reversing the underlying source of protein energy malnutrition and at other factors that may be contributing to weight loss.
Pathogenesis
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