HIV-associated wasting in the era of HAART: a practice-based approach to diagnosis and treatment.

Wasting remains an important, yet often overlooked, condition in HIV-infected patients receiving HAART. Successful office-based management depends on early diagnosis by bioelectric impedance analysis and on a multifaceted approach to treatment. Immediate goals include controlling viral load, correcting any immediate causes of wasting, and improving nutritional intake. Should wasting persist despite these measures, various therapies may be initiated. These include testosterone replacement therapy in hypogonadal patients, recombinant human growth hormone, anabolic steroids, progressive resistance exercise, and experimental therapies. Early treatment of HIV-associated wasting restores body cell mass, improves quality of life, and reduces the frequency of opportunistic infections and hospitalizations.