HIV wasting involves:
(1) involuntary weight loss >= 10% of baseline (either over 3 months or time not dependent)
(2) presence of either
(2a) chronic diarrhea for >= 30 days
(2b) weakness and fever for >= 30 days
Causes of wasting in HIV disease:
(1) anorexia
(1a) anxiety and depression
(1b) cytokines
(1c) medication-related
(2) difficulty with nutritional intake
(2a) difficult or painful chewing
(2b) difficulty swallowing
(2c) nausea and vomiting
(3) increased nutritional demands related to systemic infections
(4) diarrhea
(4a) chronic bacterial infection
(4b) chronic parasitic infection
(4c) viral infections
(4d) malabsorption
(4e) drug-related
(5) reduced testosterone in men
Interventions that can reduce or prevent wasting:
(1) HAART (high active antiretroviral therapy)
(2) anti-diarrheal agents
(3) increased fiber in the diet
(4) nutritional planning (smaller meals, selection of foods, vitamins, etc.)
(5) enteral or parenteral feedings
(6) antidepressants if depressed
(7) appetite stimulants
(8) testosterone replacement in males
(9) exercise
(10) possibly growth hormone
(11) control of nausea
(12) treatment of systemic infections
(13) therapy for malabsorption
(14) treatment of intestinal infections
