(BETA) Wasting Syndrome: Decreased food intake, not increased metabolism, causes weight loss

(BETA) Wasting Syndrome: Decreased food intake, not increased metabolism, causes weight loss

Bulletin of Experimental Treatments for AIDS, No. 26; September 1995
Harvey Bartnof, MD

Research in the past has indicated that HIV positive individuals and people with AIDS have a higher baseline rate of metabolism than HIV negative people. That increased metabolism was felt to be a significant factor in HIV-associated weight loss. New research from the St. George's Hospital Medical School in London indicates that decreased intake of food and calories is the cause of HIV wasting, rather than an increase in baseline metabolism. The report was published in the July 6, 1995 New England Journal of Medicine. The lead author is D.C. Macallan.

The amount of total daily calories expended by healthy HIV positive people was the same as for HIV negative people: 2,750 kilocalories. During rapid weight loss among HIV positive individuals, total daily calories expended decreased to 2,180 kilocalories. This decrease in caloric expenditure was due to decreased physical activity. However, during the same rapid weight loss period, daily intake decreased to 1,330 kilocalories per day. This resulted in a negative daily calorie balance which caused the weight loss, according to the authors.

While the results of the study conflict with past findings, the implications for maintaining weight are significant. Regular monitoring of weight among HIV positive individuals is important. At the first sign of a weight decrease, the addition of medication(s) to help maintain appetite and calorie intake should be considered. Medications that improve the appetite and/or facilitate weight gain include megestrol acetate (Megace), dronabinol (Marinol), and human growth hormone (Serostim). An evaluation to find an infection or cancer that may be causing the weight loss is important. Modifying the diet is also important; persons with HIV are advised to frequently eat smaller meals comprised of high-calorie foods.

Macallan DC and others. Energy expenditure and wasting in human immunodeficiency virus infection. New England Journal of Medicine 333(1): 83-88. July 6, 1995.

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