Losing weight can be a serious concern for people with HIV. But there are ways to safely and effectively combat HIV weight loss.

Read on to find out why HIV weight loss can be serious and what can be done to prevent and treat this issue.

HIV weight loss, sometimes called HIV wasting syndrome, is an unplanned weight loss of more than 10 percent of body weight with either diarrhea or weakness and fever that lasts more than 30 days.

This type of weight loss often occurs with more advanced HIV. Lean body mass (LBM) tends to be lost, but weight loss may be body fat as well.

While antiretroviral therapies (ART) have helped lower rates of this weight loss, estimates from 2016 suggested that between 14 and 38 percent of people with HIV will experience it.

The risk of death does increase with each 1 percent increase in weight loss from baseline weight in people living with HIV. Moreover, this risk rises by 11 percent with each 1 percent increase in weight loss from the prior visit.

HIV weight loss can result from a mix of factors such as:

Opportunistic infections

Opportunistic infections (OIs) can occur because the immune system is weakened from HIV, resulting in weight loss. HIV wasting has been tied to OIs such as:

  • Mycobacterium avium complex
  • cytomegalovirus infection
  • Pneumocystis pneumonia
  • tuberculosis

Altered nutrition

Pain and trouble chewing and swallowing due to mouth sores along with feeling full quickly due to problems within the gastrointestinal (GI) tract can limit food intake.

HIV and OIs can break down the lining of the small intestine and lessen the amount of nutrients absorbed.

Neurologic disease, such as cryptococcal meningitis, can affect food intake or perception of hunger, as well as the ability to eat.

Food insecurity or lack of access to healthy foods due to psychosocial or financial concerns can also lead to HIV weight loss.

Metabolic and hormone changes

HIV can raise resting energy expenditure (REE) or the number of calories burned at rest.

Low calorie intake is one of the main reasons for HIV weight loss, but REE can hasten weight loss.

Hormone levels can also influence metabolism, and HIV may alter levels of hormones needed to maintain weight and grow and repair muscles. These include:

  • thyroid hormones
  • testosterone
  • growth hormones and factors

Those with hypogonadism may also be prone to weight loss. This occurs when the sex glands make little to no sex hormones, such as testosterone.

Low testosterone levels may result in the slowing of protein synthesis, or the creation of proteins in the body, causing a decrease in LBM.

High levels of cytokines or cell proteins may also induce inflammation as a way to incite the immune response. The body responds by making more fats and sugars but less protein, leading to reduced LBM.

Medication side effects

Certain medications, such as ART, used to treat HIV may cause a loss of appetite or nausea and vomiting. Drug interactions can boost blood levels of these drugs, which can worsen these issues.


Certain drugs that treat HIV can cause lipodystrophy or the transfer of fat from one area of the body to another.

This can cause a loss of fat in areas such as the face, arms, buttocks, and legs but a gain fat in areas such as the stomach, chest, upper shoulders, and the back of the neck.

Mental health conditions

Those living with HIV may also have mood, anxiety, or cognitive conditions, such as:

  • depression
  • HIV-associated dementia
  • substance use disorder

The stress of living and caring for HIV can impact mental health. HIV and related health issues can also change the way the brain and nervous system work.

Certain medications used to treat HIV may also have side effects that can influence the way someone thinks and behaves. They may eat fewer healthy foods or less often as a result.

Wider introduction and use of ART has been linked to increased weight gain and cases of overweight and obesity in people living with HIV.

Those with overweight and obesity may have a higher body mass index (BMI) and a higher ratio of BMI to visceral fat, a type of body fat stored in the abdominal cavity. It wraps around vital organs such as the pancreas and liver.

Compared to the general population, having this ratio combined with HIV may raise the risk for health issues such as heart disease, type 2 diabetes, and certain cancers.

For instance, data from 2016 found that for every 5 pounds someone with HIV gains, the risk for diabetes goes up by 14 percent, compared to 8 percent in the general population.

For those with overweight or obesity and HIV, losing weight may improve overall health and lessen the risk of some health issues.

Lifestyle and self-care measures can help with maintaining weight. These include:

  • eating a healthy diet with a good balance of calories and nutrients, such as protein for building and keeping muscle mass
  • working out routinely to strengthen and boost muscle mass
  • seeking help from a licensed therapist for mental health support
  • finding healthy ways to keep stress in check

Tips for dealing with weight loss in HIV

Talk with a doctor or healthcare professional about weight loss of 5 or more pounds without trying, especially if the weight stays off or keeps getting lower.

Below are other healthy measures to help cope with HIV weight loss:

  • Talk with a doctor about loss of appetite or an upset stomach when eating. They can discuss options such as changing medications or taking a nutrition supplement to ease symptoms and coat the stomach.
  • Connect with a registered dietitian for help with an eating plan and boosting daily calories in a safe and healthy way.
  • Eat bland foods to curb diarrhea or nausea and vomiting. Take small sips of clear liquids such as water first and slowly add soft and then solids foods. Hydrate with fluids with electrolytes but no added sugar.
  • Drink high-calorie protein shakes or smoothies to replace or add to meals and eat protein bars and other healthy snacks between meals to boost calories.
  • Eat more small meals throughout the day if larger meals are hard to finish.
  • With mouth sores, avoid citrus fruits and foods that are spicy, hard or crunchy, or too hot or cold. Use a straw for drinking liquids.
  • Talk with a doctor about taking nutritional supplements to boost nutrient intake.
  • Strength train routinely with an emphasis on resistance training to build and restore muscle mass. Ask a doctor for a referral to an exercise physiologist or physical therapist if needed.
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Treatment measures for HIV weight loss can include:

  • ART to lower risk for OIs, including those of the GI tract
  • appetite stimulants, such as Remeron, Megace, and Marinol (the synthetic form of a substance found in cannabis), to counteract loss of appetite and promote weight gain
  • human growth agents, such as Serostim, to increase weight and lean body mass while decreasing fat mass
  • anabolic agents, such as testosterone, to help build muscle mass
  • antiemetics (anti-nausea drugs), such as Zofran and Compazine, to control nausea and vomiting
  • anti-inflammatory drugs that curb cytokine production, such as thalidomide, in rare instances

HIV weight loss or wasting is a serious health issue that often occurs later in the course of HIV. Factors such as OIs, nutrition and GI issues, HIV drug side effects, and mental health conditions can play a key role in how and why it develops.

Lifestyle and self-care measures such as eating nutrient- and protein-rich foods, strength training regularly, and keeping stress in check can help prevent and curb the effects of HIV wasting.

Treatment options such as ART and appetite stimulants may also be options to speak about with a doctor or healthcare professional.