Management of HIV Wasting Syndrome

Abstract

Because of the potential for advances, it is appropriate to periodically revisit the criteria for the diagnosis and treatment of the wasting syndrome associated with progressive HIV infection. There are several influences with the potential to alter the clinical management of this complication. These include evolving options for HIV control with the potential to alter the risk and the presentation of HIV wasting. In addition, more detailed information about the mechanisms of wasting has the potential to generate new approaches for early detection, prevention, and treatment. As a clinical entity and target of intervention, HIV wasting must be distinguished from other common metabolic complications of HIV or its therapies that do not affect energy storage and expenditure. In particular, abnormalities of lipid and glucose metabolism associated with HIV and the lipodystrophies associated with antiretroviral therapies may produce clinical symptoms readily confused with HIV wasting. Better methodology to differentiate these complications from loss of body cell mass, the defining pathologic event of HIV wasting, is needed to accelerate the introduction of appropriate management. This supplement provides a summary of the diagnosis and treatment of HIV wasting since the introduction of highly active antiretroviral therapy (HAART) in 1996. A meta-analysis of clinical trials evaluating the most common therapies for HIV wasting has been combined with the deliberations of a collaborative panel of scientists and clinicians with an interest in nutrition and HIV infection. The consensus panel was convened with the intention of identifying new opportunities to improve early diagnosis and effective intervention for HIV wasting. The goal was to build on existing guidelines in the context of developments relevant to metabolic abnormalities in individuals infected with HIV. The emphasis was placed on incorporating new information with the potential to strengthen a rational approach to diagnosis and therapy. The chief objectives of the collaboration were to define HIV wasting and the risks posed in the modern era of antiretroviral therapy; identify optimal methods for diagnosis of HIV wasting; and define appropriate strategies for effective therapy. A summary of current research in the context of clinical management was the planned product of discussion. Specific clinical recommendations appropriate for clinical application were sought. Previous efforts to provide clinical guidance for HIV wasting were reconsidered. In the era of HAART, considerable progress has been made in the definition of HIV wasting and in the development of therapies that reverse this process. The meta-analysis included in this supplement identified 18 clinical trials evaluating the efficacy of therapies for HIV wasting published in English since 1996. Combined with the evolving options for long-term control of HIV, a review of guidelines to address the complex and interrelated clinical issues integral to prevention and treatment of HIV wasting is timely. In this supplement, the current status of HIV wasting will be addressed in 3 sections: pathogenesis and risks of HIV wasting; challenges to diagnosis of HIV wasting; and consensus recommendations for screening, preventing, and treating HIV wasting.