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Weight loss
Weight loss, or wasting, is one of the commonest symptoms of HIV infection, and can occur at any stage of infection. It needs to be taken seriously because unintentional loss of weight is often a sign that you may have an active HIV-related infection or disease. Malnutrition can also reduce the effectiveness of the immune system.This Factsheet should be read in conjunction with Factsheet 39 on Lipodystrophy, which considers the changes in body shape which can occur in some people taking anti-HIV drugs.
Causes of weight loss
Weight loss occurs when the body is using up more nutrients than it is absorbing from food. This can happen for several reasons during HIV infection:
- HIV itself can increase the rate at which the body uses nutrients (increased metabolism)
- HIV itself can alter the lining of the gut, making it harder to absorb nutrients (malabsorption)
- other gut infections can cause malabsorption and/or diarrhoea
- you may eat less than you used to (and need to) because of loss of appetite during ill-health
- specific conditions may make it harder to eat, such as mouth and throat infections
- some drugs may suppress your appetite or cause side-effects that put you off food, such as nausea, vomiting, indigestion or altered taste
Preventing weight loss
The most important ways to prevent weight loss are to treat HIV-related infections promptly, and to ensure that your nutritional intake is adequate. It is much easier to prevent weight loss in the first place, rather than to try to regain it afterwards.
It is sensible to arrange to see an NHS dietitian soon after you are diagnosed HIV-positive, rather than to delay until you have already started to lose weight. Some large clinics have dietitians who specialise in the needs of people with HIV.
A dietician can help you look at your diet to ensure that you have an adequate intake of all the main types of nutrients, and recommend any changes to fit in with any drugs you are taking and to help you cope with problems such as nausea. If necessary you may be prescribed food supplements or drinks to increase your nutritional intake. This is particularly important during or immediately after periods of ill-health.
You can help by taking symptoms such as loss of appetite, persistent nausea and diarrhoea seriously and seeking prompt medical advice. Your doctor may be able to help by treating the cause, or offering medicines to relieve the symptoms, or if the problems are themselves caused by treatments, by prescribing alternative drugs.
Good hygiene when preparing food and thorough cooking will help to reduce the chance of getting gut infections such as Salmonella and Campylobacter. Other precautions such as boiling drinking water and avoiding contact with human or animal faeces can cut down the risk of contracting parasites such as Cryptosporidium.
Treatment with anti-HIV drugs often leads to a significant increase in weight. Effective anti-HIV therapy is increasingly seen as a key element in a strategy to avoid or reverse weight loss. By boosting the immune system, it may also be the best available therapy for gut parasites such as Cryptosporidium and Microsporidium, which are hard to treat directly.
However, weight loss can still occur in people taking anti-HIV drugs and needs to be taken very seriously as studies have shown that losing 10% of your body weight in a six month period is an indicator that you could become seriously ill because of HIV, even if you continue to take your anti-HIV medication.
Encouraging weight gain
If you have lost weight after an HIV-related infection, a dietitian may recommend increasing your calorie and protein intake to try to regain it. You might be offered appetite stimulants, although these tend to encourage weight gain in the form of fat, rather than muscle which is more important.
Some clinics may prescribe a short course of anabolic steroids, to be used in conjunction with gentle weight-training exercise, or you may be offered the drug human growth hormone on an experimental basis. Some studies suggest that these can lead to increased muscle mass and improved survival.