HIV wasting syndrome (cachexia) is defined as the progressive, involuntary weight loss seen in patients with HIV. The U.S. Centers for Disease Control and Prevention (CDC) classified HIV wasting as an AIDS-defining condition in 1987, and characterized it by the following criteria:
- Weight loss of at least 10 percent
- Occurring in the presence of diarrhea or chronic weakness
- Documented fever
- Lasting for a duration of at least 30 days
- Not attributable to a concurrent condition other than HIV infection itself
Wasting (cachexia) should not be confused with weight loss, the latter of which implies the loss of body weight. By contrast, wasting refers to the loss of body size and mass, most notably lean muscle mass. It is possible, for example, for someone with HIV to lose significant muscle mass while experiencing an increase in body fat.
What causes HIV wasting syndrome?
During HIV infection, the body can consume a lot of its energy reserves. In fact, studies have shown that people with HIV — even those who are otherwise healthy and asymptomatic — will burn 10 percent more calories on average than people with no infection. Since protein in fat more easily converted to energy than fat, the body will generally metabolize muscle protein first when supplies are either depleted or unavailable in the blood.
The depletion of serum protein can be the result of either malnutrition or a malabsorptive disorder in which the body is simply unable to absorb nutrients. In cases of HIV wasting, chronic diarrhea is most commonly associated with nutritional malabsorption, and may be the result of HIV itself as the virus causes damages to the mucosal tissues of the intestines.
This gradual (and sometimes profound) loss of muscle mass is most often noted in people with AIDS, although it can occur at any stage of HIV infection.
HIV wasting and antiretroviral therapy
Before the advent of combination antiretroviral therapy (ART), the prevalence of wasting was estimated to be as high as 37 percent. Yet, despite the effectiveness of ART, wasting still remains a significant concern. Some studies suggest that anywhere from 20 to 34 percent of patients will experience some degree of wasting, albeit not at the catastrophic levels previously seen.
While ART is known to improve weight loss and malnutrition in people living with HIV, it may not necessarily prevent the loss of muscle mass or replace it once body weight is restored. More concerning still is the fact that the loss of as little as 3 percent of muscle mass can increase the risk of death in patients with HIV, while the loss of more than 10 percent is associated with a four- to six-fold greater risk.
Treating and preventing HIV wasting
There is currently no standardized approach to treating HIV wasting since there are often overlapping factors contributing to the condition (e.g. concomitant disease, drug treatment effects, malnutrition). However, there are general guidelines to follow in order to more effectively address weight loss and wasting in people with HIV:
- Initiation of ART to reduce the risk of opportunistic infection, including those of the gastrointestinal tract.
- Adjustment of diet to increase caloric intake by 10 percent (and up to 30 percent in those recovering from illness). The dietary balance of fats, carbohydrates and protein should remain the same.
- Ensure regular exercise, focusing on resistance training to build or sustain muscle mass.
- Liquid nutritional products (like Boost VHC, Ensure Plus or Nestlé Nutren) may be helpful in people who have difficulty eating solid food or those who eat but are unable to gain weight. However, like all dietary supplements, these are not meant to replace a proper, balanced diet.
- While the efficacy of testosterone replacement therapy (TRT) remains unclear in case of HIV wasting, it may be called for in instances where testosterone deficiency (hypogonadism) is noted.
- Used alone or in combination with TRT and other steroids, the use of human growth hormone (HGH) can help restore muscle mass in most cases, although the treatment is extremely expensive in the U.S.
In August 1996, after aggressive lobbying from AIDS activists, Human Growth Hormone (HGH) was granted accelerated approval in the United States for the treatment of AIDS wasting syndrome. It is one of only three Food and Drug Administration (FDA) approved uses for HGH.
In a recent study of treatments for AIDS related wasting, HGH was found to have similar efficacy to the other two major treatments, testosterone and anabolic steroids. All three showed a significant benefit over placebo. However, HGH may have advantages in terms of increasing muscle function and quality of life.
Clinical studies, including two randomized trials, have confirmed that HGH can reduce abdominal fat and increase muscle mass in people taking anti-HIV treatment. These improvements in body composition are paralleled by increases in oxygen uptake, the ability to carry out moderate physical exercise, and the capacity for high-intensity exercise.
The current HGH regimen for AIDS wasting consists of a daily injection administered at bedtime to mimic the natural cycle of growth hormone release into the bloodstream. The dose is 4-6 mg, based upon body weight. The average cost for HGH therapy for AIDS wasting is approximately $250 per day. Due to pressure from AIDS activists, Serono Laboratories, which produces a version of HGH known as Serostim, capped the cost of their HGH at $36,000 per calendar year for qualified individuals. The company provides the drug free of charge beyond this point. The leading providers of HGH worldwide are Eli Lilly Humatrope and Novo Nordisk Norditropin, but the cost of these brands can often exceed $50,000 per year.
As with so many medications sold in the United States today, these brands can be purchased in other countries for a fraction of this cost, and medical tourism in Mexico has boomed as a result. Every year millions of Americans cross into Baja California to receive treatment in clinics in Tijuana and Ensenada that they simply cannot afford in the United States.
—BajaMedica is an American owned Stem Cell clinic in Ensenada that has been providing men’s health services to the LGBT community since 2012 and has become the leading provider of HGH and TRT therapies in Baja. U.S. laws allow Americans to cross the border legally with a three month’s supply of non-narcotic medications including HGH and testosterone. They carry the leading brands of Humatrope and Norditropin at an annual cost that is one-third of the cost in California. For many these savings can mean the difference between being able to afford the treatment or not. Located just 1.5 hours south of San Diego, BajaMedica provides shuttle services to those who can’t drive down. All initial consultations are free and blood tests are available which are not shared with any U.S. insurance companies or government agencies, guaranteeing your privacy. Contact them today to learn more about your options when living with HIV.
(Graphic by www.canstockphoto.com)