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A. Systemic Complaints

Fever, night sweats, and weight loss are common symptoms in people living with HIV and may occur without a complicating opportunistic infection. Patients with persistent fever and no localizing symptoms should nonetheless be carefully examined and evaluated with a chest radiograph (Pneumocystis pneumonia can present with subtle respiratory symptoms), bacterial blood cultures if the fever is greater than 38.0°C, serum cryptococcal antigen, and mycobacterial cultures of the blood. Abdominal CT scans can be considered to evaluate occult intrabdominal infections or cancers. If these studies are normal, patients should be observed closely. Antipyretics are useful to prevent dehydration.

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Centers for Disease Control and Prevention. 2018 quick reference guide: recommended laboratory HIV testing algorithm for serum or plasma specimens. https://stacks.cdc.gov/view/cdc/50872
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Erlandson  KM  et al. HIV and aging: reconsidering the approach to management of comorbidities. Infect Dis Clin North Am. 2019;33:769.
[PubMed: 31395144]  
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Pahwa  S  et al. NIH Workshop on HIV-associated comorbidities, coinfections, and complications: summary and recommendation for future research. J Acquir Immune Defic Syndr. 2021;86:11.
[PubMed: 33306561]  

1. Weight changes

Weight loss is a particularly distressing complication of long-standing HIV infection. Patients typically have disproportionate loss of muscle mass, with maintenance or less substantial loss of fat stores. The mechanism of HIV-related weight loss is not completely understood but appears to be multifactorial, with some of the older thymidine analog medications implicated. In the setting of the newer medications, weight gain has been seen with ART, with the mechanisms and interactions currently being examined.

A. PRESENTATION

Patients with AIDS frequently suffer from anorexia, nausea, and vomiting, all of which contribute to weight loss by decreasing caloric intake. In some cases, these symptoms are secondary to a specific infection, such as viral hepatitis. In other cases, however, evaluation of the symptoms yields no specific pathogen, and it is assumed to be due to a primary effect of HIV. Malabsorption also plays a role in decreased caloric intake. Patients may suffer diarrhea from infections with bacterial, viral, or parasitic agents.

Exacerbating the decrease in caloric intake, many patients with AIDS have an increased metabolic rate. This increased rate has been shown to exist even among asymptomatic people living with HIV, but it accelerates with disease progression and secondary infection. Patients with AIDS with secondary infections also have decreased protein synthesis, which makes maintaining muscle mass difficult.

B. MANAGEMENT

Several strategies have been developed to slow AIDS wasting. In the long term, nothing is as effective as ART, since it treats the underlying HIV infection. In the short term, effective fever control decreases the metabolic rate and may slow the pace of weight loss, as does treating any underlying opportunistic infection. Food supplementation with high-calorie ...

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