At the IX International Conference on AIDS, the Treatment Action Group (TAG) debuted its recent treatment publication, The Wasting Report: Current Issues in the Treatment and Research of HIV-Associated Wasting and Malnutrition. Written by TAG’s Tim Horn and David Pieribone, The Wasting Report is the first activist publication to concentrate on issues surrounding wasting disease. Dr. Donald Kotler, one of the nation’s leading experts on wasting (St. Luke’s/Roosevelt Hospital and Medical Center, New York), was the main advisor for the project.
HIV wasting is a multifactorial complication of HIV disease, involving complex interactions among HIV, the opportunistic infections and malignancies, chronic activation of the immune system, gastrointestinal organ destruction and endocrine and immune system dysregulation. Much remains to be learned about the pathogenesis, diagnosis and treatment of HIV-associated wasting. Evidence accumulated over the years indicates that weight loss, and particularly loss of lean body mass leads to shortened survival in people with HIV disease. HIV infection often results in the overall dysregulation of the body’s metabolism, where an abnormally high metabolic rate leads to excessive breakdown (catabolism) of body protein. This is especially evident during the course of an opportunistic infection.
There is currently no consensus for the diagnosis of patients presenting with HIV-associated weight loss. Some doctors recommend a conservative approach, with no invasive diagnostic techniques and routine use of standard anti-diarrheal medications. The problem of this anachronistic approach is that wasting symptoms, casually lumped together under the term “AIDS enteropathy,” often turn out to be, upon proper diagnosis, treatable opportunistic infections. Some might remain untreatable, but proper diagnosis is essential in effective treatment and management of symptoms. The most commonly employed diagnostic techniques in HIV wasting do not adequately discriminate between loss of body weight in general and loss of lean body mass in particular. New assays, such as bio-electrical impedance analysis (BIA), may provide a clearer picture of lean body mass depletion.
Treating HIV-associated wasting conditions is critically dependent on proper diagnosis and an appropriate nutritional regimen. Treatments range from anti-emetics (anti-vomitting drugs) to appetite stimulants, anti-diarrheals, metabolic treatments such as growth hormone or anabolic steroids, to cytokine modulators. There is currently no standard-of-care treatment for many aspects of HIV-related wasting, and effective treatments for several as-yet untreatable infections, such as cryptosporidiosis and microsporidiosis, are urgently needed. TAG’s complete set of recommendations for advancing the research, diagnosis and treatment of HIV-related wasting and malnutrition can be found within The Wasting Report.