Significant weight loss (wasting)   

Low Body Mass Index (BMI): For adults, BMI < 18.5 indicates malnutrition and for children, BMI < 16 indicates severe malnutrition   

Muscle wasting: Visible thinning of arms, legs, and face (loss of fat pads) and protruding ribs. 

Common symptoms:   

• Tiredness   

• Weakness   

• Feeling cold   

• Loss of appetite or inadequate food intake   

Other signs:   

  - Dry, thin skin   

  - Brittle hair or hair loss   

  - Possible swelling of ankles (oedema) in severe protein malnutrition   

Micronutrient deficiencies can lead to specific issues:   

  - Vitamin A deficiency: night blindness   

  - Iron or folate deficiency: anaemia (fatigue, pallor)   

  - Zinc or vitamin B deficiencies: skin rashes   

Malnutrition in AHD often coexists with micronutrient deficits and anaemia. Severe malnutrition (cachexia or wasting syndrome) leads to little energy for movement or daily activities and increased susceptibility to infections.  

• Diagnosing malnutrition involves both clinical assessment and measurements. Tracking weight and BMI over time is fundamental – unintentional weight loss of >5-10% is a red flag. Mid-upper arm circumference can be used in resource-limited settings to screen for malnutrition.   

• Laboratory tests can support the assessment: albumin levels are often low in malnutrition (though albumin can also drop due to inflammation), and prealbumin is another marker.   

• Blood tests might show anemia and low levels of vitamins/minerals.   

• Clinicians also assess dietary intake history and look for physical signs of nutrient deficiencies.   

• In children with HIV, growth charts are used; failure to thrive or stunting can indicate malnutrition. Overall, diagnosis is usually apparent from weight and appearance along with corroborating labs.  

• The mainstay of treatment is nutritional rehabilitation – providing adequate calories, protein, and micronutrients to promote weight gain and rebuild tissues. This often means therapeutic feeding: a diet high in protein and energy.   

• Depending on severity, treatment can range from outpatient nutrition support (counseling on a balanced diet, food supplements) to inpatient care for severe malnutrition using refeeding protocols (like ready-to-use therapeutic foods – e.g. Plumpy’Nut – in resource-poor settings).   

• High-protein supplements or shakes are often given. Micronutrient supplementation is important: a broad multivitamin supplement covering vitamin A, B-complex, C, D, E, and minerals (zinc, selenium, iron if needed, etc.) is typically provided, because malnutrition is often accompanied by these deficiencies. If specific deficits are identified (like iron deficiency anemia or vitamin D deficiency), they should be addressed with targeted supplements.   

• It's also crucial to treat the underlying OIs or causes of malnutrition: for example, provide anti-diarrheal treatment and oral rehydration for chronic diarrhea, treat oral thrush so the patient can eat with less pain, and of course start effective ART. ART itself is one of the most effective ways to reverse HIV-associated wasting – as the virus is controlled, appetite improves and metabolism normalizes.   

• During nutritional rehab, careful monitoring is needed to avoid refeeding syndrome (especially in severely malnourished patients, who might need slow introduction of nutrition).   

• Sometimes appetite stimulants (like megestrol acetate) are used for severe anorexia, but these have to be weighed against side effects. In summary, treatment combines dietary support, supplements, managing infections, and ART in a holistic approach.  

Preventing malnutrition in people with HIV involves ensuring they maintain good nutritional intake throughout their illness. Key strategies:   

• Food support programs for those with food insecurity (many HIV care programs provide nutritional support in the form of food baskets or fortified blended foods to patients with low BMI).   

• Early initiation of ART is crucial – by treating HIV before it advances, we reduce the occurrence of wasting and maintain better absorption of nutrients (HIV can cause malabsorption even before advanced stages).   

• Regular nutrition assessment and counseling should be part of HIV care: patients are educated on eating a balanced diet rich in proteins (meat, fish, eggs, legumes), carbohydrates (whole grains), and healthy fats, as well as fruits and vegetables for vitamins.   

• Safe food hygiene is also emphasized to prevent infections that cause diarrhea. Micronutrient supplementation (like vitamin A, zinc) is provided in areas where deficiencies are common or in patients who show signs of deficiency.   

• Another aspect is managing symptoms that interfere with eating – for instance, provide anti-nausea medication if needed, treat pain, and manage depression or psychosocial issues that could reduce appetite.   

• Community support and involvement of family can help ensure the patient gets adequate meals and encouragement to eat. In children, preventing malnutrition includes promoting breastfeeding for HIV-exposed infants (with maternal ART to prevent transmission) or providing safe formula with adequate calories.   

Ultimately, malnutrition in AHD is addressed by a combination of medical, nutritional, and social interventions. By breaking the HIV-malnutrition cycle (improving diet and treating HIV/OIs), patients can gain weight, regain strength, and improve their immune function, which in turn helps them better fight their infections.