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15.10.2014

Fatigue and weight loss differential diagnosis, labyrinthitis treatment chiropractor - Try Out

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See related patient information handout on nutrition and exercise in patients with HIV, written by the authors of this article.
HIV-related wasting is a starvation state characterized by protein–energy malnutrition in which mobilization of fat is accompanied by loss of somatic and visceral proteins. Plasma HIV RNA must be assessed, and HIV infection must be aggressively treated to bring the HIV RNA level to below the limits of detection, if possible. The leading causes of involuntary weight loss are depression (especially in residents of long-term care facilities), cancer (lung and gastrointestinal malignancies), cardiac disorders and benign gastrointestinal diseases.
Weight loss of as little as 5 percent in patients with HIV infection is associated with an increased risk of disease progression. Opportunistic infections commonly associated with wasting syndrome include disseminated Mycobacterium avium complex infection, cytomegalovirus infection and Pneumocystis carinii pneumonia.
Medications that may cause nausea and vomiting, dysphagia, dysgeusia and anorexia have been implicated. The risk of mortality was significantly higher in the men who lost weight than in those whose weight did not decrease.
Loss of body cell mass carries a particularly poor prognosis, and aggressive measures should be taken to stop such depletion.


Patients exhibiting unexpected weight loss should be carefully examined to exclude decreased food intake, malabsorption, occult infection or neoplasm as the etiology of the weight loss. Tuberculosis may also be an important consideration, especially among inner-city residents, injection-drug users, the homeless and other high-risk groups. A specific cause is not identified in approximately one quarter of elderly patients with unintentional weight loss.
Early aggressive treatment of HIV disease and underlying opportunistic pathology, along with adequate pharmacologic, hormonal, nutritional and physical therapy, can often restore normal weight and body composition. In addition, occult malignancy, particularly B-cell lymphoma, may present as wasting syndrome.DRUG EFFECTSSeveral medications commonly used in the treatment of HIV disease, especially antiretroviral agents, macrolide antibiotics and chemotherapy, may cause anorexia, nausea or vomiting.
A reasonable work-up includes tests dictated by the history and physical examination, a fecal occult blood test, a complete blood count, a chemistry panel, an ultrasensitive thyroid-stimulating hormone test and a urinalysis. Wasting syndrome is included in the current case definition of acquired immunodeficiency syndrome (AIDS), as specified in 1993 by the Centers for Disease Control and Prevention (CDC). In addition, drug interactions can increase serum levels of offending medications, exacerbating the problem.GASTROINTESTINAL DISORDERSTables 1 and 2 summarize gastrointestinal conditions that commonly interfere with nutritional intake in patients with HIV infection.
The CDC defines wasting syndrome as unexplained weight loss of more than 10 percent, accompanied by fever or diarrhea.


Pain, impaired deglutition and early satiety related to upper gastrointestinal tract pathology may limit food intake.6 Other conditions not intrinsically related to HIV, such as dental caries, gallbladder disease, peptic or duodenal ulcerative disease and gastroesophageal reflux, may cause pain and limit food intake, thus contributing to the development of wasting syndrome.
The development of wasting syndrome is considered an indicator condition for AIDS.Wasting syndrome in patients with human immunodeficiency virus (HIV) infection is a multifactorial process that can be associated with a variety of infectious, neoplastic, metabolic and nutritional abnormalities. Consideration should be given to the patient's environment and interest in and ability to eat food, the amelioration of symptoms and the provision of adequate nutrition.
Early identification and treatment can improve functional status and, perhaps, survival as well. Food and Drug Administration has labeled no appetite stimulants for the treatment of weight loss in the elderly.
Accurate evaluation is essential, however, because this problem is associated with increased morbidity and mortality.1,2 When a patient has multiple medical problems and is taking several medications, the differential diagnosis of unintentional weight loss can be extensive.



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