Current Issues in Research and Treatment of HIV-Associated Wasting and Malnutrition
by Tim Horn & David Pieribone
From the Introduction
Wasting syndrome can be a chronic and deadly manifestation of HIV. Multiple studies demonstrate that progressive weight loss and wasting are highly predictive of disease progression and death. However, wasting syndrome has been underemphasized, not only in clinical care, but also in basic clinical research. Currently, no standard of care exists for monitoring HIV-infected people for malnutrition, wasting and weight loss, and there is no clear consensus regarding the optimal ways to diagnose and treat these complications of HIV disease.
Progressive weight loss and wasting during the course of infection and illness is not a new phenomenon. In fact, much of the data generated by those investigating HIV-related wasting are based on research into cancer, sepsis, and the social ills of poverty. Unfortunately, given the complexities of HIV pathogenesis and its related opportunistic infections, weight loss and wasting in the course of HIV infection poses characteristics unseen in other diseases causing weight loss.
Despite the tremendous progress made in developing antiretroviral therapies, prophylaxis, and treatments for opportunistic infections, the prevalence of wasting syndrome is increasing. Two studies have reported that a ten-fold increase in wasting syndrome as the initial AIDS-defining illness has occurred since 1987 (Hoover 1993, Weiss 1993). The current CDC definition of wasting as an AIDS-defining illness may be misguided in light of the recent research into this multifactorial complication and so data from AIDS related weight loss and wasting epidemiology studies may be highly under-reported.
Research into HIV-related wasting syndrome has yielded advancement in understanding the epidemiology, multifactorial etiology and pathogenesis, and its potential treatments. However, much like HIV-disease itself, there is a great deal more to learn about the complexities of wasting syndrome and the ways in which it can be managed.
The aim of this report is three-fold: First, to put the complexities and current understanding of weight loss and wasting into a useful context for non-nutrition scientists, people with HIV/AIDS and their caregivers. Second, to evaluate the data thus far accumulated in its epidemiology, basic science, diagnosis, and treatment of weight loss and wasting. Finally, to pass recommendations intended to streamline research and provide more conclusive research in all aspects of AIDS-related wasting in an attempt to implement a standard of care for all patients infected with HIV.
To read the rest of the report, please download the pdf.