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A. Systemic Complaints

Fever, night sweats, and weight loss are common symptoms in HIV-infected patients 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 without respiratory symptoms), bacterial blood cultures if the fever is greater than 38.5°C, serum cryptococcal antigen, and mycobacterial cultures of the blood. Sinus CT scans should be considered to evaluate occult sinusitis. If these studies are normal, patients should be observed closely. Antipyretics are useful to prevent dehydration.

Centers for Disease Control and Prevention. 2018 quick reference guide: Recommended laboratory HIV testing algorithm for serum or plasma specimens.
Erlandson  KM  et al. HIV and aging: reconsidering the approach to management of comorbidities. Infect Dis Clin North Am. 2019;33:769.
[PubMed: 31395144]  
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 loss and wasting syndrome

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.


AIDS patients 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 AIDS patients have an increased metabolic rate. This increased rate has been shown to exist even among asymptomatic HIV-infected persons, but it accelerates with disease progression and secondary infection. AIDS patients with secondary infections also have decreased protein synthesis, which makes maintaining muscle mass difficult.


Several strategies have been developed to slow AIDS wasting. In the long term, nothing is as effective as antiretroviral treatment, 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 drinks may enable patients with not much appetite to maintain their intake. Selected patients with otherwise good functional status and weight loss due to unrelenting nausea, vomiting, or diarrhea may benefit from total parenteral nutrition (TPN). It should be ...

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