HIV related wasting syndrome or Anorexia Nervosa?

Abstract

Introduction: Weight loss late in the course of HIV disease is common. Unwanted loss of more than 10% of body weight with either diarrhea or weakness and fever for 30 days is considered as HIV related wasting syndrome. We present a patient with a reported intentional weight loss of 40% in 6 months and a prior diagnosis of Anorexia Nervosa, who presented with symptoms characteristic of wasting syndrome. Case report: 40 year-old HIV positive Caucasian female was referred to the eating disorders department due to suspected Anorexia Nervosa by a regional psychiatric institution where she was treated for the last month. On physical examination the patient was pale, asthenic (BMI 18 kg/m2), hypotensive (BP 100/60 mm Hg) with tachycardia (105 bpm), she had general fatigue and difficulties walking without assistance. On a mental status examination, she was well oriented in person but disoriented in space and time and MMSE could not be performed. She presented symptoms characteristic of cognitive and memory impairment (could not recall recent events or chronology of events, had difficulty concentrating and sustaining attention) and psychological changes (apathy, withdrawal, inappropriate behaviour). According to herself and her sister, for the last 6 months she had been restricting calories and lost around 30 kg but could not recall vomiting or when she tested positive with HIV. She expressed she does not eat because has no appetite and feels constant malaise. Medical history revealed the patient was accidentally diagnosed with AIDS (CD4+ 16 cells/mm3), had positive toxoplasmosis IgG and cytomegalovirus serology results 1 month ago has since received antiretroviral therapy with Rezolsta 800mg/150mg daily and Combivir 150mg/300mg twice a day. Upon admission, internal feeding through a nasogastric tube with 1400 kcal/day was initiated together with vit. B1 intravenously for prevention of refeeding syndrome. While waiting [...].