The causes of wasting syndrome are complex. First, it is necessary to exclude or treat opportunistic infections (TB, MAC, cryptosporidiosis and microsporidiosis). If there are none to be found, several reasons remain that may contribute, even in combination, to wasting syndrome. These include metabolic disorders, hypogonadism, poor nutrition and malabsorption syndromes (overview: Grinspoon 2003).

Therefore it is important to start with a thorough history. Does the patient have a sensible diet? How are meals distributed throughout the day? Is the patient depressed? Which drugs, which HAART is being taken? Distinction to antiretroviral-related lipodystrophy syndrome is often difficult, particularly in cases of lipoatro-phy. Significant weight loss is also typical for HCV therapy with interferon (Garcia-Benayas 2002), but rapidly resolves after finishing treatment. In addition, hypo-gonadism should be ruled out (measurement of testosterone). There are several simple tests for malabsorption syndromes. It is prudent to start with testing albumin, TSH and cholesterol levels.

Further tests such as D-xylose absorption or biopsies of the small intestine should only be initiated after consulting a gastroenterologist. Other tests to determine body composition (DEXA, densitometry, bioelectrical impedance analysis) should only be conducted in centers experienced in wasting syndrome in AIDS patients.

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