HIV and Weight Loss: Root Causes, Remedies, and Safety Considerations
People living with HIV may experience weight loss due to a variety of factors, including opportunistic infections, nutrient deficiencies, metabolic changes, and mental health conditions. Understanding these causes and implementing appropriate treatments can help maintain or restore nutritional status.
Causes of Weight Loss
- Opportunistic Infections (OIs): OIs such as cytomegalovirus (CMV), Mycobacterium avium complex (MAC), and cryptosporidiosis can cause diarrhea, gastrointestinal symptoms, and malabsorption, leading to nutrient loss and weight loss.
- Nutrient Deficiencies and Malabsorption: HIV impairs nutrient absorption and utilization. Oral and esophageal lesions due to candidiasis, herpes simplex, or Kaposi’s sarcoma can impair swallowing and reduce appetite. Diarrhea from OIs or GI tract hypermotility further worsens nutrition.
- Metabolic and Body Fat Changes: Early HIV treatments led to fat loss (lipoatrophy) and metabolic disruption due to mitochondrial toxicity of drugs like stavudine and zidovudine. Modern antiretroviral regimens with integrase strand transfer inhibitors (INSTIs) and tenofovir alafenamide (TAF) tend instead to cause weight gain, but some dysregulated fat distribution and metabolism abnormalities persist.
- Mental Health Conditions: Depression, anxiety, and HIV-associated neurocognitive disorders can reduce appetite and motivation to eat, contributing to weight loss.
- HIV Medications: Older drugs caused fat wasting and metabolic problems, while newer drugs (INSTIs, TAF) are more associated with weight gain rather than loss. However, side effects like nausea and appetite suppression from some treatments may contribute to weight loss in some cases.
Treatments for Weight Loss
- Manage Opportunistic Infections: Treat infections causing diarrhea and malabsorption to restore digestion and nutrient absorption.
- Nutritional Support: Assess and support oral intake consciously, including checking for oral/esophageal lesions, providing appropriate treatment, using oral supplements or enteral nutrition as required, correcting specific nutrient deficiencies, ensuring hydration, and using intravenous fluids when necessary for severe cases.
- Address Medication Side Effects and Regimen Optimization: Avoid or switch from drugs associated with lipoatrophy or metabolic disturbances when possible. Monitor weight and body composition changes.
- Physical Activity and Resistance Training: To preserve muscle mass and improve nutritional status, especially when weight loss is present or when starting weight-loss medications.
- Mental Health Care: Screen for and treat depression or anxiety that can impair appetite and nutritional intake.
Tips for Improving Appetite and Preventing Weight Loss
- Do resistance and weight lifting exercise.
- Make food enjoyable and tasty.
- Eat smaller meals more frequently throughout the day.
- Drink high-calorie protein shakes between meals.
- Avoid citrus, spicy, or very hot or cold foods if the mouth is sore.
- Eat bland foods for an upset stomach.
Foods to increase calorie intake include butter, salad dressing, sour cream, cream cheese, avocado, olive oil, carbohydrates like potatoes, rice, pasta, fresh and dried fruit, oatmeal, bread, and crackers.
In summary, managing weight loss in people living with HIV requires a multidisciplinary approach, focusing on infection control, nutritional support, medication management, physical rehabilitation, and psychological care. A healthy, nutritious diet, higher in calories and protein, can help prevent the loss of muscle mass. If excess weight is a concern, it can increase the risk for type 2 diabetes, high blood pressure, high levels of fat in the blood, heart disease, inflammation, and other health issues. If people have lipodystrophy, they can discuss treatment options with a doctor.
- Science has shown that HIV-positive individuals may face weight loss due to various factors, including mental health conditions, sexual health complications, and metabolic changes in the body.
- To tackle these weight loss issues, medical-conditions such as opportunistic infections need to be managed judiciously, with medications designed to combat them and restore digestion.
- A crucial aspect of treatment is nutritional support, which can involve addressing nutrient deficiencies, ensuring adequate hydration, and providing oral supplements or enteral nutrition when needed.
- Fitness and exercise, particularly resistance and weight training, play a significant role in preserving muscle mass and improving nutritional status for those experiencing weight loss.
- Mental health conditions like depression or anxiety, which can reduce appetite and motivation, must be identified and treated promptly to help prevent further weight loss.
- CBD, a popular natural supplement, could potentially provide additional benefits for some HIV patients, as it may help with appetite stimulation and managing anxiety or depression symptoms. However, more research is needed to confirm its effectiveness and safety in this context.
