Young black male portraying doctor and older white male discussing, not actual Serostim® patients

HIV‑associated Wasting

What is HIV‑associated wasting?

HIV‑associated wasting is an HIV‑related condition characterized by abnormalities in protein synthesis, proteolysis, and lipid metabolism.2 Over time, patients living with HIV may experience unintentional weight loss, which may manifest as a preferential loss of LBM and a relative preservation of fat.3,4 The loss of LBM may be associated with a decline in strength and in the ability to complete tasks.5,6

Who may be at risk?

HIV‑associated wasting is a serious, underdiagnosed condition that may impact a range of patients living with HIV, including those who are well controlled on ART.7,8

HIV‑associated wasting may affect a range of patients 2,7-9

Many of your patients may be at risk for HIV‑associated wasting, including:

  • Newly diagnosed patients
  • HIV Long-Term Survivors
  • HIV‑positive patients with normal CD4 counts and controlled viral loads
  • Patients on ART who fail to gain weight
  • Patients on ART with acute infection
  • Patients with advanced HIV disease
  • Poor virologic responders
  • Patients who have been nonadherent to ART

More men experience HIV‑associated wasting, but it can occur in women, too.

Many factors contribute to HIV‑associated wasting2,5

The exact causes of HIV‑associated wasting remain unknown and are unique to every patient. HIV‑associated wasting is a diagnosis of exclusion. There are several factors associated with altered metabolism and/or reduced caloric intake that may result in unintentional weight loss in your patients living with HIV.

Opportunistic infections (OIs)7,11-13

  • OIs related to HIV have been shown to increase the risk of unintentional weight loss and may lead to metabolic changes

Inflammatory response14-16

  • Persistent HIV infection leads to long-term immune activation and chronic inflammation, even in HIV‑positive patients on ART with undetectable viral loads
  • In patients living with HIV, this chronic, systemic inflammatory response leads to the ongoing loss of LBM, which may lead to unintentional weight loss


  1. Serostim® (somatropin) for injection [prescribing information]. Rockland, MA: EMD Serono, Inc.
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  3. Dudgeon WD, Phillips KD, Carson JA, Brewer RB, Durstine JL, Hand GA. Counteracting muscle wasting in HIV‑infected individuals. HIV Med. 2006;7(5):299-310.
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  5. Grinspoon S, Mulligan K; for the Department of Health and Human Services Working Group on the Prevention and Treatment of Wasting and Weight Loss. Weight loss and wasting in patients infected with human immunodeficiency virus. Clin Infec Dis. 2003;36(Suppl 2):S69-S78.
  6. Grinspoon S, Corcoran C, Rosenthal D, et al. Quantitative assessment of cross-sectional muscle area, functional status, and muscle strength in men with the acquired immunodeficiency syndrome wasting syndrome. J Clin Endocrinol Metab. 1999;84(1):201-206.
  7. Wasserman P, Segal-Maurer S, Wehbeh W, Rubin DS. Wasting disease, chronic immune activation, and inflammation in the HIV‑infected patient. Top Clin Nutr. 2011;26(1):14-28.
  8. Erlandson KM, Li X, Abraham AG, et al. Long-term impact of HIV wasting on physical function. AIDS. 2016;30(3):445-454.
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  10. Macallan DC. Wasting in HIV infection and AIDS. J Nutr. 1999;129(1S Suppl):238S-242S.
  11. Jacobson DL, Bica I, Knox TA, et al. Difficulty swallowing and lack of receipt of highly active antiretroviral therapy predict acute weight loss in human immunodeficiency virus disease. Clin Infect Dis. 2003;37(10):1349-1356.
  12. Chu C, Selwyn PA. Complications of HIV infection: a systems-based approach. Am Fam Physician. 2011;83(4):395-406.
  13. Melchior JC, Raguin G, Boulier A, et al. Resting energy expenditure in human immunodeficiency virus-infected patients: comparison between patients with and without secondary infections. Am J Clin Nutr. 1993;57(5):614-619.
  14. Deeks SG, Tracy R, Douek DC. Systemic effects of inflammation on health during chronic HIV infection. Immunity. 2013;39(4):633-645.
  15. Chang HR, Dulloo AG, Bistrian BR. Role of cytokines in AIDS wasting. Nutrition. 1998;14(11-12):853-863.
  16. Castaneda C. Muscle wasting and protein metabolism. J Anim Sci. 2002;80(suppl 2):E98-E105.
  17. Grinspoon S, Corcoran C, Lee K, et al. Loss of lean body and muscle mass correlates with androgen levels in hypogonadal men with acquired immunodeficiency syndrome and wasting. J Clin Endocrinol Metab. 1996;81(11):4051-4058.
  18. Grinspoon S, Corcoran C, Miller K, et al. Body composition and endocrine function in women with acquired immunodeficiency syndrome wasting. J Clin Endocrinol Metab. 1997;82(5):1332-1337.
  19. Melmed S. Disorders of the anterior pituitary and hypothalamus. In: Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 19th ed. McGraw-Hill; 2015.