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Wasting, anyone notice a risk factor?

  • 1.  Wasting, anyone notice a risk factor?

    Posted 7 days ago
    I'm wondering if there is a known risk for developing cachexia such as being on a particular med or having a particular comorbidity.   Anyone?

    Samuel Samalin
    Los Angeles CA

  • 2.  RE: Wasting, anyone notice a risk factor?

    Posted 13 hours ago

    I found this quick read on mechanism, risk factors, and therapeutic strategies for Cachexia, anorexia, non malignant and malignant weight loss in Science Direct.

    Henry Delu
    Los Angeles CA

  • 3.  RE: Wasting, anyone notice a risk factor?

    Posted 10 hours ago
    Edited by Michael Harbour 10 hours ago
    Hi Samuel,
    There is no one mechanism or risk factor for HIV associated wasting (HIVAW).  Its cause can be multifactorial.  In 1987, the CDC definition of wasting was involuntary weight loss accompanied by chronic diarrhea, fever, and weakness for 30 days without an underlying cause.  ART changed the incidence of and prevalence of HIVAW, and now the definition evolved to be unintentional weight loss and loss of lean body mass.   The definition now includes:
    • 10% loss of body weight over 12-month period
    • 5% loss of body weight over 6-month period
    • BMI <20 kg/m2
    There is no specific ICD-10 code for HIVAW, so cachexia or weight loss is often co-listed with the HIV diagnosis.  It is an important condition to recognize because HIVAW is a predictor of mortality and morbidity in HIV patients.  It can occur despite adequate HIV viral control.  The multifactorial risk factors of HIVAW include the following:
    1.  Socioeconomic status and food insecurity
    2.  Mechanical factors such as difficulty swallowing
    3.  Poor appetite
    4.  Depression
    5.  Substance use and dependence
    6.  Diarrhea or malabsorption
    7.  Chronic infection and malignancy
    8.  Hormonal diseases like Hypogonadism or Hyperthyroidism
    9.  Metabolic changes and/or increased metabolic demand
    10.  Cytokine excess (IL-1, IL-6, TNF)

    Weight loss can also lead to frailty in the HIV elderly population as this is one of the defining criteria.  Again, this is another reason to quickly identify HIVAW.  In this era of telemedicine and virtual visits, diagnosing weight loss can be delayed as the physician may not "see" the patient and the patient may not bring it up.  Unfortunately, HIVAW is no longer discussed in the DHHS Guidelines or even the new edition of Fundamentals of HIV Medicine which makes searching for this information including treatment more challenging.  I recently presented an abstract on the prevalence of HIVAW in the Modern ART Era at the Miami Center for AIDS Research Conference in February 2021 and would be happy to get you a copy if you wish.

    Michael Harbour, MD, MPH, FACP, AAHIVS
    Palo Alto CA