If you or a loved one has recently been diagnosed with HIV, you may come across terms like “HIV-associated muscle wasting” or “HIV wasting syndrome.” These terms can be confusing and even scary, especially when you’re learning about the virus and its symptoms. While they sound similar, muscle wasting and wasting syndrome refer to different aspects of the physical changes that can occur in people living with HIV.
In this blog post, we’ll explain what HIV-associated muscle wasting is, how it relates to wasting syndrome, and what can be done to manage these conditions.
What is HIV-Associated Muscle Wasting?
HIV-associated muscle wasting refers to the unintentional loss of muscle mass in people with HIV. This can happen when the body starts breaking down muscle tissue for energy because it isn’t getting enough nutrients or calories, or because the immune system is fighting the virus or other infections.
Muscle wasting is a specific kind of weight loss—it’s not just about losing fat, but the actual reduction in muscle mass. People who experience muscle wasting often feel weaker, have less energy, and struggle with tasks that were once easy. This loss of muscle can make it harder to stay active and maintain daily routines, which can further impact overall health.
What Causes Muscle Wasting in HIV?
There are several factors that contribute to muscle wasting in people living with HIV:
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- Chronic inflammation: HIV causes inflammation in the body as the immune system continuously fights the virus. Over time, this inflammation can lead to muscle breakdown. In particular, inflammation affects the way the body processes protein, which is critical for maintaining muscle mass.
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- Increased energy demands: HIV and associated infections place higher demands on the body. The immune system works overtime, burning more calories, even at rest. This energy deficit can lead to muscle loss if the body doesn’t have enough nutrients or calories to compensate.
- Increased energy demands: HIV and associated infections place higher demands on the body. The immune system works overtime, burning more calories, even at rest. This energy deficit can lead to muscle loss if the body doesn’t have enough nutrients or calories to compensate.
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- Malnutrition and malabsorption: Many people with HIV experience digestive problems, including difficulty absorbing nutrients from food. This malabsorption, combined with a decreased appetite or gastrointestinal issues like diarrhea, can lead to malnutrition. Without enough protein and other essential nutrients, the body starts breaking down muscle tissue for energy.
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- Opportunistic infections: People with advanced HIV are more susceptible to infections that further deplete their body’s resources. Chronic infections can lead to fever, fatigue, and digestive issues, which can make it difficult to eat enough and contribute to weight and muscle loss.
HIV Wasting Syndrome: How Is It Different from Muscle Wasting?
While HIV-associated muscle wasting refers specifically to the loss of muscle mass, HIV wasting syndrome is a broader term used to describe more generalized weight loss in people with HIV. Wasting syndrome is defined as an involuntary loss of at least 10% of body weight, typically accompanied by diarrhea, chronic weakness, and fever lasting over 30 days.
Wasting syndrome includes both the loss of muscle and fat tissue. It’s a more severe condition that usually occurs in the later stages of HIV when the immune system is significantly compromised, and it involves a combination of factors, including malnutrition, muscle wasting, and systemic inflammation.
The key differences between the two are:
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- Muscle wasting is specifically about losing muscle mass, which can happen at any stage of HIV, often as a result of the body’s increased energy needs or nutrient deficiencies.
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- Wasting syndrome is a more advanced condition that involves the loss of both muscle and fat, and it typically includes other symptoms like chronic illness, weakness, and fever. Wasting syndrome occurs more often in people whose HIV is not well-controlled, particularly if they are not on antiretroviral therapy (ART).
How to Manage HIV-Associated Muscle Wasting
The best way to prevent or manage muscle wasting is through early and consistent treatment with antiretroviral therapy (ART). ART helps suppress the virus, reduce inflammation, and allow the immune system to recover. By keeping HIV under control, ART can slow down or even stop the progression of muscle wasting.
Here are other strategies to manage muscle wasting:
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- Nutrition: A diet rich in calories, protein, and essential nutrients is critical. People with muscle wasting may need to eat more than they usually would to make up for increased energy demands. A nutritionist can help create a diet plan that includes high-protein foods and supplements if necessary.
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- Exercise: Strength training and resistance exercises are important for maintaining and rebuilding muscle mass. While it might feel challenging, even light exercises can help slow muscle loss and improve strength over time.
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- Treat underlying conditions: Managing infections and other complications associated with HIV is essential. Treating gastrointestinal problems, for instance, can improve nutrient absorption and help with weight gain.
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- Medications: In some cases, doctors may recommend medications to help prevent muscle loss or increase appetite. Anabolic steroids or testosterone replacement therapy may be used to help rebuild muscle mass in those with significant muscle loss.
HIV-associated muscle wasting and HIV wasting syndrome are serious conditions, but they can be managed with proper care. Understanding the differences between the two can help you and your healthcare team address the specific needs related to muscle loss and overall weight loss. By starting and sticking with antiretroviral therapy, maintaining a nutritious diet, and staying active, it’s possible to manage these symptoms and live a healthy life with HIV. If you or a loved one is experiencing muscle wasting, reach out to a healthcare provider to develop a personalized plan for managing it.
Sources and Links
Nemechek, P. M., Polsky, B., & Gottlieb, M. S. (2000). Treatment Guidelines for HIV-Associated Wasting. Mayo Clinic Proceedings. https://doi.org/10.4065/75.4.386
Eric Mittelmann, MD. (2024). Neuromuscular and Myopathic Complications of HIV: Overview, Pathophysiology, Epidemiology. Medscape. https://emedicine.medscape.com/article/1167729-overview
Just Diagnosed. (2024). VA.gov | Veterans Affairs. va.gov. https://www.hiv.va.gov/patient/diagnosis/oi-wasting-syndrome.asp
Nutrition and HIV. (2024). The Well Project. https://www.thewellproject.org/hiv-information/nutrition-and-hiv
Erlandson, K. M., Li, X., Abraham, A. G., Margolick, J. B., Lake, J. E., Palella, F. J., Jr, Koletar, S. L., & Brown, T. T. (2015). Long-term impact of HIV wasting on physical function in the Multicenter AIDS Cohort Study. AIDS. https://doi.org/10.1097/qad.0000000000000932