Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Division of Infectious Diseases, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Clin Infect Dis. 2024 Sep 20;79(Supplement_2):S63-S75. doi: 10.1093/cid/ciae407.
The era of modern antiretroviral therapy (ART) has markedly improved health and survival among persons with human immunodeficiency virus (HIV) (PWH). In the pre-ART era, wasting was associated with HIV disease progression to acquired immunodeficiency syndrome and death. Effective ART has reduced the prevalence and incidence of this pre-ART form of HIV-associated wasting. However, a subgroup of ART-treated virally suppressed PWH continue to lose weight, often accompanied by aging-related comorbidities and/or functional deficits. For this subgroup of patients, the older definition of HIV-associated wasting (HIVAW) cannot and should not be applied. An expert panel comprising the authors of this white paper convened to review the existing definition of HIVAW and to create an updated definition that they termed HIV-associated weight loss, based on clinically defined parameters among contemporary PWH receiving ART. Here, clinical features and laboratory biomarkers associated with HIV-associated weight loss are reviewed and approaches to screening and treatment are considered. Available management approaches, including the use of current US Food and Drug Administration-approved medications for HIVAW and other available therapies are discussed. The expert panel also identified knowledge gaps and provided recommendations for clinicians, payers, and researchers.
抗逆转录病毒疗法（ART）时代的到来显著改善了人类免疫缺陷病毒（HIV）感染者（PWH）的健康和生存状况。在 ART 治疗前，消瘦与 HIV 疾病进展为获得性免疫缺陷综合征和死亡有关。有效的 ART 降低了这种 ART 治疗前形式的 HIV 相关消瘦的流行率和发生率。然而，一小部分接受 ART 治疗的病毒抑制的 PWH 仍在持续减重，常伴有与年龄相关的合并症和/或功能缺陷。对于这部分患者，不能也不应该再使用旧的 HIV 相关消瘦（HIVAW）定义。本白皮书的作者组成一个专家小组，对现有的 HIVAW 定义进行了审查，并根据接受 ART 的当代 PWH 的临床定义参数，创建了一个新的定义，即 HIV 相关体重减轻。在此，回顾了与 HIV 相关体重减轻相关的临床特征和实验室生物标志物，并考虑了筛查和治疗方法。还讨论了现有的管理方法，包括目前美国食品和药物管理局批准的 HIVAW 药物和其他可用疗法的应用。专家组还确定了知识空白，并为临床医生、支付者和研究人员提供了建议。
