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HIV Wasting Syndrome
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HIV Wasting Syndrome
Sherylee Sanchez Santiago
Pharm. D. Candidate 2020
Preceptor: Kalumi Ayala
Objectives
Discuss:
Objectives
- HIV wasting syndrome
- Etiology
- Evaluation of Wasting
- Non-Pharmacologic and Pharmacologic interventions
Defined as unintended and progressive weight loss often accompanied by weakness, fever, nutritional deficiencies and diarrhea.
HIV Wasting Syndrome
The syndrome, also known as cachexia, can diminish the quality of life, exacerbate illness and increase the risk of death for people with HIV.
HIV wasting syndrome
Wasting can occur as a result of HIV infection itself but also is commonly associated with HIV-related opportunistic infections and cancers.
HIV- Associated Wasting
- One of the first signs of advanced AIDS
Definition:
- CDC: HIV-infected people who have unintentionally lost more than 10 % of their body weight with chronic fever, weakness or diarrhea (in the absence of other related illness contributing to weight loss)
- In practice: Involuntary weight loss
- Magnitude of weight loss correlates with death
Etiology
- Inadequate caloric intake ( decrease appetite, malabsortion)
- Altered metabolism (hormonal or metabolic disorders)
Evaluation of Wasting
Medical History
Nutritional Assessment
- Nutrional requirements vs. present intake
- Anthropomorphic measurements: Ht, weight, IBW, BMI
Labs
Functional Capacity Assessment
- Physical impediments, impact on activities of daily living
- CD4, VL, total protein, albumin
- Testosterone level (free and total for male patients
Psychosocial assessment
- Depression
Interventions for Wasting
Pharmacologic
Non Pharmacologic
Initiate ART
Management of concurrent disease states
Psychosocial intervention
Appetite stimulant
Interventions for wasting
Protein anabolic agents
Nutritional counseling
Anabolic/ andronergic steroids
Non-Pharmacologic Interventions for Wasting
Pharmacologic and Non Pharmacologic Intervention
- Management of concurrent disease states
- Opportunistic infections that interfere with swallowing (candidiasis, herpes, CMV esophagitis)
- Apthous ulcers
- Malignancy
- Depression
- Psychological intervention
- Depression may be an underlying cause of anorexia
- Nutritional counseling
- Maintenance of adequate food intake, high protein diet
- Maintain or increase activity levels and engage in moderate resistance exercise training when possible
Pharmacologic intervention for Wasting
Pharmacologic intervention for Wasting
Pharmacologic intervention for Wasting
Pharmacologic intervention for Wasting
Pharmacologic intervention for Wasting
Pharmacologic intervention for Wasting
References
- Mangili A, Murman DH, Zampini AM, Wanke CA. Nutrition and HIV infection: review of weight loss and wasting in the era of highly active aniretroviral therapy from the nutrition for healthy living cohort. Clin Infect Dis. 2006;42(6):836-842.
- Tang AM, Jacobson DL, Spiegelman D, Knox TA, Wanke C. Increasing risk of 5% or greater unintentional weight loss in a cohort of HIV-infected patients, 1995 to 2003. J Acquir Immune Defic Syndr. 2005;40(1):70-76.
- Dudgeon WD, Phillips KD, Carson JA, Brewer RB, Durstine JL, Hand GA. Counteracting muscle wasting in HIV-infected individuals. HIV Med. 2006;7(5):299-310.