HIV Wasting Syndrome Treatment

 

Initial treatment for HIV Wasting Syndrome includes nutrient intake of at least 100% of the Recommended Dietary Allowance, supplemented with vitamins. Also appetite stimuli treating anorexia, include Marinol (synthetic derivative of marijuana) which also may decrease nausea and improve mood, and synthetic progestational drug (Megace) contributing to weight gain and appetite (Mulligan & Schambelan, 2003). Another great technique to maintain muscle mass is daily exercise.

                In case Wasting Syndrome progresses and diarrhea is preset - “balance must be found between controlling symptoms with a low-fat diet and maintaining caloric intake with fat-containing foods that offer caloric density appetite” (Mulligan & Schambelan, 2003). Dietary and supplemental fibers may aid in water binding, thus reducing diarrhea.

                In case of worsening, or failure to improve the condition with oral intake, “enteral alimentation should be initiated” (Mulligan & Schambelan, 2003). In severe cases percutaneous endoscopic gastrostomy (PEG) feeding tubes are advised since have been proven to be effective.

                Lastly, parenteral nutrition which is getting nutrients to the body through veins, is only for most severe cases of intestinal dysfunction (ex: severe/large volume diarrhea).

Since the treatments for Wasting Syndrome in HIV don’t include antibiotics or strong medications, there aren’t many side effects to them. Only for feeding tubes may be cases when it is contraindicated.

 

 

                                                                           Williams, B., & Waters, D. (1999).

 

 

 

References

Mulligan, K., & Schambelan M. (2003). HIV-Associated Wasting. Retrieved from http://hivinsite.ucsf.edu/InSite?page=kb-04-01-08#S2X

Williams, B., & Waters, D. (1999). Evaluation and Treatment of Weight Loss in Adults with HIV Disease. American Family Physician, 60(3), 843-854. Retrieved from http://www.aafp.org/afp/1999/0901/p843.html

Signs and Symptoms of HIV associated Wasting

 

                                                                           E-Mediccal (2012)

Some of the early signs of Wasting Syndrome in HIV patients is lack of interest to food, no energy to do any activities, and feeling full with a small meal. With the treatment HIV patients undergo, and the medications they take often results in side effects such as the ulcers in the mouth, and nausea making it difficult to eat or simply enjoy meals.

Other signs include early vomiting, anorexia, and diarrhea. Usually diarrhea is associated with malnutrition and is the most obvious sign of wasting syndrome. Anorexia typically results from lack of eating that is an outcome of multiple case specific factors. Early signs of vomiting are also really strong indicators of Wasting Syndrome in HIV patients since it not only signals the condition but also transitions into a condition defining wasting.

HIV patient may also be leading a sedentary life style or is in depression. Often when an HIV patient is not exercising, he/she may lose muscle due to antiretroviral medications that may take away from muscle mass.

Another possible sign of Wasting Syndrome is the progression of HIV itself. Often, when HIV progresses and opportunistic infections weaken the immune system of the patient, it often may lead to Wasting Syndrome.

Symptoms such as vomiting and diarrhea indicate progression and are most uncomfortable. As wasting develops and progresses the signs and symptoms don’t change but do progress and pick up speed.  

 

 

References

Woolard, S. (2001). Wasting Syndrome in HIV/AIDS Patients. Advance Newsmagazine. Retrieved from http://nurse-practitioners-and-physician-assistants.advanceweb.com/article/wasting-syndrome-in-hivaids-patients.aspx?CP=2

Epidemiology of HIV- Wasting Syndrome

 

                A study- Nutrition for Healthy Living (NFHL) that has been done in Boston, US from 1995-2005 looked at 881 patients with HIV around age 40; 29% were women and 44% were non-white race. In this study some of the symptoms and causes of HI-wasting syndrome were identified. Causes that fell into two possible groups: 1) inadequate nutrient intake, and 2) altered nutrient metabolism were socioeconomic status, access to care, cultural practices, psychological factors, and medical complications of therapies.

Symptoms included inadequate nutrient intake, oral and gastrointestinal symptoms, anorexia, psychosocial-economic symptoms, malabsorption, uncontrolled HIV infection, and metabolic demands of HAART (highly active antiretroviral therapy).

33.5% of the 881 HIV infected patients met the criteria of either having 1) loss of more than 10% of body weight, 2) loss of more than 5% of body weight that was sustained for longer than 6 months and lastly 3) had a BMI (body mass index) of less than 20 (normal BMI range: 18.5-25.0).

The study showed that more men than women had diarrhea, and women showed greater deficiencies in vitamins A, C, E, and B₆.  38.4% women had insufficient caloric intake. 11.3% had inadequate protein intake, 36.1% weren’t sure where they were going to get their next meal from, and 8% identified themselves as hungry.

 

 

 

 

 

 

 

Reference

 

Mangili, A. M. Zampini, D. H. Murman, & C. A. Wanke (February 7, 2006). Nutrition and HIV Infection: Review of Weight Loss and Wasting in the Era of Highly Active Antiretroviral Therapy from the Nutrition for Healthy Living Cohort. Invited Article, CID 2006; 42, 836-842. Retrieved from http://cid.oxfordjournals.org/content/42/6/836.full.pdf+html

Pathophysiology of Wasting Syndrome (HIV)

 Emedicine Cancer, (2013)

According to Mulligan and Schambelan- “factors that have been demonstrated or hypothesized to contribute to wasting include metabolic alterations, anorexia, malabsorptive disorders, hypogonadism, and excessive cytokine production” (Mulligan & Schambelan, 2003). Since for every patient with HIV Wasting Syndrome the reason is different we need to take in consideration that the factors causing the syndrome are interdependent and aren’t always as easy to sort out.

                The first cause to HIV Wasting Syndrome is metabolic alternation. Most common contributing factor to wasting has been decreased energy intake. Also their total energy expenditure (amount of energy (calories), that a person uses to breathe, circulate blood, digest food, and be physically active) is often decreased while their resting energy expenditure (amount of calories required for a 24-hour period by the body during a non-active period) is increased correlating with decreased physical activity levels (Mulligan & Schambelan, 2003).

                Another contributing factor for wasting is anorexia; which also is affected by other factors. Possible causes for anorexia are painful oral and esophageal problems, altered taste perception, and nausea from medications. As well as restrictions from food at given times for antiretroviral treatments, lack of interest for food due to social isolation, depression, and fatigue.

                Malabsorption and diarrhea are also strong contributors for Wasting Syndrome of HIV and are common in patients that have wasting. In the study done by Schambelan and others, data shows that 50% of patients with advanced HIV had chronic diarrhea (Mulligan & Schambelan, 2003). With constant diarrhea not only does the patient not absorb the nutrients from foods eaten, but also feels discouraged to eat more when the result is evident (diarrhea).

                Another common finding in HIV Wasting Syndrome men patients was significantly decreased levels of testosterone. Although the levels of testosterone as proposed in the study may be decreased due to medications (Mulligan & Schambelan, 2003), but the fact that testosterone is responsible for body mass suggests that low levels of it may contribute to loss of muscle mass which is also a component of wasting syndrome.  

                Although there has not been enough study done on cytokine levels in HIV patients, but a common finding in those patients is elevated levels of cytokine production.

                Common factors contributing to progression include severity of HIV, low nutrient intake, no exercise, diarrhea (common in all HIV patients), and no availability to treatment and medications.

                Typically the progression of the disease, is losing weight and muscle mass, which can later be fatal. Another factor that plays a big role in progression of HIV Wasting Syndrome are opportunistic infections that occur due to weakened immune system.

 

 

References

Mulligan, K., & Schambelan M. (2003). HIV-Associated Wasting. Retrieved from http://hivinsite.ucsf.edu/InSite