• Just how should HIV-associated wasting be defined clinically? Although the Centers for Disease Control and Prevention (CDC) offered a definition in 1987, its usefulness in the clinical setting is questionable.1 Over the years, there has been a great deal of debate regarding how to define wasting, particularly in today’s HAART era.

• Recently, a distinguished panel of experts met to develop a definition of HIV-associated wasting.2 Their new criteria take into account several factors, including body composition changes, cultural and sex differences, and the changing nature of wasting.3

• According to these new guidelines, a patient must meet at least one of five criteria. For example, the diagnosis of wasting can be made if there is 10% unintentional weight loss over 12 months or a 7.5% unintentional weight loss over 6 months.

• Wasting may also be defined by the loss of 5% body cell mass within 6 months. A patient with a body mass index of less than 20 kg/m2 is also considered to have wasting.

• Changes in body cell mass may also indicate wasting. A body cell mass of less than 35% of body weight in men and a body mass index of less than 27 kg/m2 qualifies as a diagnosis of wasting. Women qualify with a lower body cell mass, specifically less than 23% of body weight. All five criteria may be applied in the clinical setting to diagnose HIV-associated wasting in men and women.

References:

1. Council of State and Territorial Epidemiologists, AIDS Program, Center for Infectious Diseases. Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. MMWR Morb Mortal Wkly Rep. 1987;36(suppl.1):1S-15S.

2. Treatment Guidelines for HIV-Associated Wasting, Consensus Development Panel Meeting, New York, NY; July 26, 2000.

3. Grinspoon S, Corcoran C, Miller K et al. Body composition and endocrine function in women with acquired immunodeficiency syndrome wasting. J Clin Endocrinol Metab. 1997;82:1332-7. [Erratum, J Clin Endocrinol Metab. 1997;82:3360.]