HIV: Current Research
Open Access

Molecular Diagnosis of HIV Wasting Syndrome

Ogbonnaya Ogbu^{* *}Correspondence: Ogbonnaya Ogbu, Department of Virology, Ebonyi State University-Abakaliki Federal Teaching Hospital, Abakaliki, Nigeria, Email:

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Opinion

Wasting syndrome, a protein-calorie malnutrition state that is prevalent in the dialysis population, is sometimes seen in earlier CKD stages as well. It is characterized by decreased relative body weight, skinfold thickness, arm muscle mass and total body nitrogen, as well as signs of macronutrient and micronutrient deficiencies.

Wasting syndrome refers to unwanted weight loss of more than 10 percent of a person's body weight, with either diarrhea or weakness and fever that have lasted at least 30 days. For a 150-pound man, this means a weight loss of 15 pounds or more. Weight loss can result in loss of both fat and muscle. Once lost, the weight is difficult to regain.

The condition may occur in people with advanced HIV disease, and can be caused by HIV, inflammation, or opportunistic infections. The person may get full easily or have no appetite at all.

Prior to the availability of effective Anti-Retroviral Therapy (ART), severe wasting and decreased levels of cholesterol were common metabolic abnormalities described in advanced Acquired Immunodeficiency Syndrome (AIDS). Descriptions of patients with body shape abnormalities such as central fat accumulation and peripheral fat loss emerged with the introduction of effective ART.

Wasting in AIDS is similar to wasting in cancer cachexia and other serious illness. These syndromes involve dysregulation of metabolism, characterized by catabolism, preferential loss of lean body mass, and, conversely, preferential gain of fat over lean mass when enteral or parenteral therapy is used. This continuous loss of cell mass and negative nitrogen balance helps to promote progression of AIDS and can hasten death.

Cachexia, also known as ‘wasting syndrome,’ is a muscle loss and wasting condition that is associated with an underlying illness. Cachexia is due to altered metabolic adaptation to an increase in muscle protein degradation. Fatigue, weakness Loss of body weight and loss of appetite are clinical hallmarks in patients with cachexia. Diseases which are commonly associated with this disorder include AIDS, cancer, multiple sclerosis, and tuberculosis. Altered metabolism, chronic illness and the persistence of pro-inflammatory cytokines are the main factors contributing to cachexia.

Malnutrition occurs in HIV for many reasons. Both illness and inactivity suppress appetite. Many of the medications used to treat HIV cause anorexia and a variety of GI side effects. Candidiasis, aphthous ulcers, and CMV disease involving the mouth and oesophagus make eating difficult and decrease oral intake.

Secondary infections including microspora, cryptosporidium, protozoa, and bacterial pathogens cause diarrhea and secondary malabsorption of nutrients. HIV causes diarrhea through villous crypt hyperplasia, lymphocyte infiltration of bowel epithelium and the development of an enteric autonomic neuropathy. Many of the well-known hepatic complications associated with HIV, as well as abnormalities of the pancreas caused by cryptococcus, pentamidine, toxoplasmosis and TB contribute to malnutrition and diarrhea. Malnutrition is further exacerbated when patients decrease oral intake in an effort to reduce diarrhea.