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Why It Happens

A number of factors may contribute to HIV‑associated wasting

HIV‑associated wasting may be of concern for many people living with HIV, even when the virus is well controlled with antiretroviral therapy. Evidence suggests that altered metabolism can have an important role in the development of HIV‑associated wasting. Although the causes of HIV‑associated wasting can be different and varied, people with HIV‑associated wasting may experience some of the factors below:


  • Infections related to HIV have been shown to increase the risk of unintentional weight loss occurring and may cause changes in metabolism


  • Inflammation is a natural body response to factors such as infection, stress, trauma, and cell injury that helps control tissue damage
  • In people living with HIV, excess inflammation affects many parts of the body, and the inflammation may become chronic or ongoing
  • If the body experiences too much inflammation, metabolism may change, muscle tissue can break down, and you may have decreased appetite or no appetite

Changes in metabolism

  • HIV may alter your metabolism, or how the body turns food into energy
  • If your metabolism is not functioning properly, your body may not be able to use carbohydrates, fats, and proteins effectively
  • Your body may draw energy from lean body mass (LBM) instead of fat
  • Losing LBM means that you are losing muscle mass and can be a sign of HIV‑associated wasting
  • This is why some people with HIV who experience unintentional loss of weight and LBM may lack energy, need to rest more often, or find it difficult to complete activities 

Endocrine disorders

  • HIV can affect the production of certain hormones, including testosterone and growth hormone, which are vital to maintaining muscle mass and bone.

Low testosterone

  • Testosterone is a hormone that helps maintain muscle mass, bone growth, adequate levels of red blood cells, and sexual function
  • Low levels of testosterone may result in significant loss of LBM in both men and women

Growth hormone (GH) resistance

  • GH promotes growth and helps regulate metabolism
  • GH resistance involves a decrease in, or absence of, the effects of GH in the body
  • Your body may have trouble using the GH it makes naturally, or it may not be making enough of the GH it needs
  • As a result, loss of LBM can occur