Metabolic and Morphologic Complications of HIV and HAART


•	Wasting still exists in patients on HAART
•	Patients need to be evaluated for wasting with BIA on an ongoing basis
•	Treatment requires a concurrent approach
•	Hypogonadal patients should receive testosterone replacement therapy
•	Growth hormone is an effective therapy
•	Steroids, PRE, supplements, and cytokine modulators may be used as adjuncts

• In conclusion, weight loss and wasting remain very common complications in the era of highly active antiretroviral therapy.

• They continue to be observed in patients treated with HAART or who have failed HAART, as well as in those patients who have never received therapy. Despite effective HAART therapy, patients are still losing weight based on current definitions.

• The percentage of lean body mass and fat mass lost depends on how much body fat a person has initially. If body fat is greater than 15%, fat mass will most likely be lost. However, if their body fat is less than 15%, then the predominant tissue lost will be lean body mass.

• With all the increased attention currently being paid to the metabolic and morphologic complications of antiretroviral therapy, the clinician must remain vigilant to the presence of HIV wasting even when patients are maintaining virologic control with HAART. It is important to make the distinction between true wasting and fat redistribution syndromes, and treat each appropriately with effective interventions.