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Emedicine
Cancer, (2013)
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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
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