HIV wasting syndrome refers to a complication of the virus in which significant weight loss accompanies fever and weakness. Potential causes of this include loss of appetite and changes in metabolism.

The main treatment is the primary HIV medication, antiretroviral therapy. This treatment reduces HIV in the blood and leads to an average 10–25% weight gain per year. To address the specific causes, doctors may prescribe additional medications, such as appetite stimulants.

HIV wasting syndrome is a sign that HIV has caused severe damage to the immune system and progressed to stage 3, commonly known as AIDS.

Keep reading to learn more about HIV wasting syndrome, including the causes, treatment, and prevention methods.

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HIV is a virus that infects the body and attacks the immune system. If a person does not receive treatment, HIV can progress to a later stage of the condition known as stage 3, or AIDS.

HIV wasting syndrome is a term for the unintentional loss of more than 10% of body weight that manifests with fever, as well as weakness or diarrhea lasting for at least 30 days. As an example, in a person weighing 130 pounds (lb), this would involve a weight loss in excess of 13 lb.

The decrease in weight can be due to the loss of both muscle and fat. It happens in the last stage of HIV, when damage to the immune system has accumulated and led to AIDS.

An older 2009 study reports that despite effective HIV treatment, weight loss remains a problem in many people with the condition. It affects nearly 10% of people with managed care plans.

HIV wasting syndrome may occur due to an array of causes. These include:

Poor nutrient absorption

Impaired nutrient absorption may stem from opportunistic infections or HIV’s direct effect on the intestinal lining, both of which reduce absorption. Opportunistic infections are those to which people with a weakened immune system are susceptible.

Diarrhea may be another cause of poor absorption because it involves a loss of nutrients and calories.

Inadequate food intake

The factors below may lead to low food intake:

  • Lack of appetite: A reduced appetite is a common HIV symptom. Furthermore, some medications may decrease appetite because of side effects, such as tingling around the mouth, nausea, and changes in the sense of taste. In addition, depression can cause a loss of appetite.
  • Infections in the mouth or throat: These infections may make eating painful. They can also cause a feeling of fullness after eating just a small amount of food.
  • Low energy: This symptom can present challenges in shopping for food and preparing meals.

Metabolism changes

HIV has a harmful effect on protein building and food digestion. The condition also changes the levels of some hormones, such as thyroid and testosterone, which can affect metabolism. People with HIV need more calories than people without the condition to maintain their weight.

The symptoms may include:

  • chronic weakness or diarrhea
  • fever that lingers for at least 1 month
  • tiredness
  • loss of more than 10% of body weight
  • loss of both lean body mass and fat mass

Learn more about the symptoms of HIV at each stage of the disease.

An older 2004 study notes that although HIV-associated wasting may be obvious in the later stages, detecting it in the early stages is more challenging because various factors can cause weight loss in people with HIV.

The authors state that when other explanations for weight loss are absent, body cell mass (BCM) provides the strongest evidence of wasting. A reduction in BCM denotes a decline in cells that use oxygen, metabolize glucose, and produce carbon dioxide.

However, doctors typically look instead for the characteristic signs of long lasting fever and an unintentional weight loss of more than 10% of body weight.

The treatment for HIV is antiretroviral therapy, which reduces the amount of HIV in the blood — the viral load. When the treatment decreases the viral load to undetectable levels, it usually leads to a weight increase of 10–25% per year.

Antiretroviral treatment can slow HIV progression and help prevent wasting. Doctors advise a person with HIV to start the treatment as soon as possible after they receive a diagnosis. Delaying treatment will result in continued harm to the immune system, while starting treatment early can help keep someone healthy for many years.

Other treatments may include:

Nausea and vomiting medications

These drugs aim to relieve the symptoms of HIV. Some people with the condition have also expressed an interest in cannabis or specific compounds in the plant, such as cannabinoids. A 2017 review looked at clinical trials that assessed the value of cannabinoids for HIV wasting. It concluded that any evidence of effectiveness is very low and that the compounds would likely cause frequent side effects.

Appetite stimulants

Sometimes, doctors prescribe appetite stimulants, such as megestrol acetate (Megace) and dronabinol (Marinol). However, both medications have downsides. Megace produces the side effects of blood clots, diabetes, and bone problems. Marinol is a synthetic form of marijuana, which may cause psychosis, addiction, and blood pressure changes.

Reducing diarrhea

The impaired immunity of HIV leaves a person at risk of opportunistic infections that can cause diarrhea. Doctors attempt to treat them, but certain ones are very hard to eradicate.

The best form of treatment will be antiretroviral therapy, as this prevents further weakening of the immune system and leads to weight gain.

Hormone treatments

The Food and Drug Administration (FDA) has approved the human growth hormone somatropin (Serostim) to increase weight and lean body mass. However, as this medication is very costly and can cause severe side effects, some experts believe that dosages lower than the FDA-approved dosage may be preferable and still effective.

Researchers are studying other hormone treatments, such as testosterone and muscle-building agents. One example is 19-nortestosterone (Nandrolone).


Progressive resistance training is a type of workout that uses weights and machines to increase lean muscle mass. Exercise also offers the additional benefits of strengthening bones, improving cholesterol levels, and elevating mood.

According to the Department of Veterans Affairs, the right kind of diet can help. The optimal diet may differ from the low fat, low calorie diet that doctors typically recommend for individuals with a good health status. People with HIV need more protein and calories than the standard recommended amounts to prevent muscle mass loss.

Examples of foods to add to the diet include:

  • peanut butter
  • cheese
  • milkshakes
  • beans and peas
  • eggs
  • instant breakfast drinks
  • sauces

Learn more about nutrition and diet in relation to HIV and AIDS.

Research from 2016 explored the long-term consequences of HIV wasting. It compared the physical function of the below three groups:

  • 85 men with HIV who survived at least 2 years following wasting
  • 249 men with HIV who did not have wasting
  • 338 men without HIV or wasting

The results of the research indicate that HIV wasting has a negative effect on muscle strength and physical quality of life for years after the stabilization of body weight. The authors cite prior studies that link low body weight, poor strength, or both with the following:

The authors note that these effects could lead to a loss of independent living. They also point out that earlier studies suggest that unintended weight loss predicts the risk of death more strongly than measures of lean mass, fat mass, or BCM.

Once wasting syndrome appears, it means a person has AIDS. Without treatment, the typical survival time is 3 years.

Doctors define HIV wasting syndrome as an unintentional loss of more than 10% of body weight alongside fever and weakness or diarrhea lasting 30 days or more.

The condition leads to an array of causes stemming from HIV-associated problems with appetite, digestion, and absorption.

Antiretroviral therapy, which reduces HIV viral load, can lead to weight gain. In addition, doctors may prescribe other medications to address specific causes. They may also recommend adding extra sources of protein to the diet.

Wasting can lead to a loss of muscle strength and impair quality of life due to the resulting physical limitations.