Definition of HIV-Associated Wasting

Clearly, the early CDC definition of wasting was useful for epidemiological purposes. Its clinical utility, however, is questionable. Not all patients with wasting have associated symptoms, such as diarrhea or fever. Since the CDC definition was developed in 1987, there has been much debate regarding an expanded definition for HIV-associated wasting that will be useful in the clinical setting. Such a definition needs to take into account cultural and sex differences. For example, early studies of men focused on the loss of lean body mass and muscle wasting. We know today that women lose more fat than lean body mass. Substantial depletion of lean body mass does occur, however, in women with advanced HIV disease who have a body weight <90% of ideal weight.28

Developing a clinical definition of HIV-associated wasting became an important charge of the Consensus Development Panel. After taking into account body composition changes in the era of HAART, cultural and sexual differences, and the changing nature of wasting, the Panel developed and proposed a definition of HIV-associated wasting which can be applied and used in the current clinical setting.