Understanding Severe Malnutrition In Patients With HIV and AIDS

By Allison Nitsch, MD, FACP, CEDS

Around the world, 33 million people live with human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS). As time passes, more people are living longer with HIV than ever before, thanks to innovative medical treatments that are prolonging lives.

While many people are able to stay well for many years after contracting HIV, an HIV diagnosis can increase your risk for many health concerns, including becoming severely malnourished or underweight. This piece outlines the risk factors associated with malnourishment and weight loss in individuals with HIV/AIDS and how to get help for these issues.


Malnourishment and HIV/AIDS: A Cause for Concern

One of the hallmarks of HIV is that the virus can increase your risk of becoming malnourished or underweight. Fortunately, the incidence of “wasting” in patients with HIV has decreased with utilization of Highly Active Antiretroviral Therapy (HAART). Some individuals living with HIV/AIDS are suffering from malnourishment even though they do not appear to be underweight. Others may look as though they are “starving.”

  • Malnutrition and weight loss (sometimes referred to as “wasting”) are core features of the progression of HIV/AIDS; these features are also associated with higher rates of impairment and mortality.
  • The disease is called “slim disease” in parts of Africa because malnutrition and weight loss are so common for people living with HIV/AIDS in that part of the world.
  • While living in a resource-rich country like the United States may decrease your chances of becoming severely malnourished or underweight, the risk is still present, particularly if dehydration, metabolism changes, mouth sores, diarrhea, nausea or vomiting make it harder for you to eat nutritious foods or keep weight on.

When the body’s immune system is compromised due to HIV, specific nutrients, including vitamins and minerals, are even more necessary to maintain healthy functioning and reduce infection risk. When people with HIV/AIDS can’t properly nourish their bodies, their immune systems aren’t fully supported, and health problems will inevitably arise.

Unfortunately, many medical providers are not trained to identify or address the life-threatening complications that accompany severe malnutrition, underscoring the need for HIV/AIDS patients to be assessed and treated in an inpatient medical setting that specializes in this field.

Concerning malnutrition symptoms to watch for in individuals with HIV/AIDS include:

  • Low body weight or rapid weight loss
  • Micronutrient deficiencies such as vitamin D, vitamin C, zinc and thiamine
  • Low prealbumin
  • Other physical findings of malnutrition such as low heart rate, low temperature and muscle loss


The Risk for Refeeding Syndrome

When individuals living with HIV/AIDS are severely malnourished or underweight, they can’t just try to “eat more” or “gain weight” on their own. If they begin eating too much, too rapidly, they could face a life-threatening medical complication known as refeeding syndrome.

Refeeding syndrome is serious and can be fatal. The lower a patient’s weight is, the higher the risk for complications during refeeding. Also, patients who have lost weight rapidly, even if they are still at a “normal” body weight range may also be at increased risk for refeeding syndrome. Marked by a shift in fluids and electrolytes within the body, the shifts associated with refeeding syndrome are due to moving from a state of tissue breakdown (catabolism) to a state of building up of tissue (anabolism).

Due to the risk factors involved with refeeding and the potential for fatal complications, patients with severe malnutrition stemming from HIV are wise to seek weight restoration and nutritional rehabilitation at a medically supervised weight restoration and/or refeeding center that can manage co-occurring diagnoses. Once medical stability is achieved, the patient can return home.


If You Are Malnourished and Living with HIV/AIDS

Malnutrition on its own is a major health concern. In HIV-infected individuals, malnutrition is associated with worse health outcomes. If you are seeking treatment for malnourishment and you are living with HIV/AIDS, the staff at ACUTE can initiate the assessment process so you can get started with treatment as soon as possible. Providing you with emotional support and 24/7 monitoring, ACUTE’s providers will work around the clock to:

  • Ensure appropriate antiretroviral therapy
  • Correct electrolyte imbalances treat and prevent infections
  • Treat nutrient deficiencies
  • Evaluate for and treat co-occurring medical issues
  • Treat co-occurring psychiatric issues
  • Initiate other medical treatments, as needed

Tube feeding either intravenously (parenteral nutrition) or via the gastrointestinal tract (enteral nutrition) is also available.


If You Are Underweight and Living with HIV/AIDS

What should individuals do if they are underweight but not necessarily suffering from malnutrition? Like the increased risk for malnutrition, weight loss can be common for those living with HIV/AIDS due to a loss of appetite, malabsorption of nutrients, inflammation and other causes. As the illness progresses, weight loss can become harder and harder to treat, pointing to the urgency to seek help as soon as concerning symptoms are noted.

If an individual’s body mass index (BMI) drops to 15 or below, the risk of dying increases, and the need for treatment becomes far more critical. The safest place to seek weight restoration and nutritional rehabilitation is in a medically supervised environment with access to multidisciplinary specialists that can support adequate nutrition intake.


Everyone Deserves a Chance to Survive and Recover — We Can Help.

Whether due to decreased food intake, metabolic changes, fevers, infections or other factors, effective treatment exists for malnutrition and weight loss caused by HIV/AIDS. The team of experts at ACUTE has established protocols to address malnutrition concerns and nutrition support, specializing in safe refeeding protocols. Our location within Denver Health hospital allows us to seamlessly consult specialists (such as Infectious Disease physicians) as needed for further testing and treatment.

Along with nutritional rehabilitation and refeeding, ACUTE offers:

  • A specialized inpatient medical stabilization with telemetry
  • Behavioral health support
  • Physical and Occupational therapy
  • Child-life
  • Pet therapy
  • Gender and sexuality affirming care
  • Chaplain services (upon request)

No patient is “too sick” for ACUTE. We work closely with air ambulance transport providers to ensure that patients facing extreme medical instability are not denied treatment. To help these patients get the lifesaving care they need, ACUTE partners with elite air ambulance providers to get patients to our unit at Denver Health safely and swiftly, usually within 48 hours.


We Are Here for You and Your Family When Experience Matters

The medical, social and emotional aspects of HIV/AIDS care should not be overlooked. If you have been told that there is nothing you can do to improve your weight or nutritional status, we’d like to give you a second opinion. Every day, the specialists at ACUTE provide comfort and restore health in patients that have nowhere else to turn to. Thoughtfully trained in culturally responsive care, our providers are passionate about helping all patients live a healthy and affirmed life.

Should you choose to seek treatment with us, we will help you find the best chance at a full and lasting recovery. No matter how extreme your illness, we will work diligently by your side to provide the medical and behavioral health support and care that you need.



Written by

Allison Nitsch, MD, FACP, CEDS

Dr. Allison Nitsch obtained her Bachelors degree in Chemical Engineering from The University of Texas at Austin. She then matriculated to Texas A&M Health Science Center where she completed her…

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