Revisiting HIV-Associated Wasting: Results from a U.S. Cross-Sectional Survey of Health Care Providers’ Knowledge, Attitude, and Current Practices

Advancements in antiretroviral therapy (ART) have significantly improved morbidity and mortality rates among people with human immunodeficiency virus (HIV) (PWH), leading to prolonged survival, and many are now living into middle and old age. However, this population now faces aging-related comorbidities, including cachexia HIV-associated wasting (HIVAW), which remains inadequately addressed in the context of contemporary ART. Effective management of HIVAW requires a multifaceted approach that targets underlying causes while addressing coexisting health conditions. Currently, recombinant human growth hormone (rhGH) (somatropin) is the only FDA-approved treatment for HIVAW that increases body weight and lean body mass and improves physical endurance. However, the lack of standardized definitions and clear treatment guidelines may contribute to the underdiagnosis and suboptimal management of HIVAW. This study aimed to assess health care providers' (HCPs) knowledge, attitudes, and contemporary clinical practices regarding HIVAW through a cross-sectional survey conducted in collaboration with the American Academy of HIV Medicine. Approximately half of the respondents recognized a 3% prevalence rate of HIVAW, noting its association with increased morbidity and health care resource utilization. However, nearly one-third faced challenges in diagnosing HIVAW due to unclear definitions, highlighting the need for standardized clinical guidelines. Less experienced providers demonstrated less familiarity with treatment options like rhGH compared to their more experienced colleagues. While 88.4% identified nutritional supplements as a management strategy, only 32.2% were aware of an FDA-approved treatment for HIVAW, indicating a substantial knowledge gap. This study underscores the need for enhanced educational initiatives and clear treatment guidelines to improve the recognition and management of HIVAW, particularly among less experienced HCPs.