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Clinical Review

Investigation and management of unintentional weight loss in older adults

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1732 (Published 29 March 2011) Cite this as: BMJ 2011;342:d1732

Rapid Response:

HIV infection as a cause of unintentional weight loss in the elderly

It was with great interest that we read the clinical review by McMinn
et al on investigation and management of unintentional weight loss in the
elderly (1). However, we would like to highlight that HIV infection can
also be a cause of weight loss in this age group.

The UK National HIV testing guidelines published in 2008 (2) list
weight loss of unknown cause as an indicator condition which should prompt
the offer of an HIV test. National data (3) demonstrates that the
proportion of patients aged >50 accessing HIV services has more than
tripled between 2000 to 2009 and now represents 1 in 5 of all patients.
This is due to an ageing cohort of people previously diagnosed as well as
an increase in new diagnoses among the over 50s. New diagnoses among older
adults more than doubled between 2000 and 2009, and accounted for 13% of
all diagnoses in 2009. Two-thirds (67%) were diagnosed late, with a CD4
cell count less than 350 per mm3 which confers a worse prognosis in terms
of mortality and morbidity.

In our own department, we have diagnosed a number of patients aged
greater than 65 with the oldest patient aged 80. Many of these patients
have had missed opportunities for testing and have been in contact with
various healthcare services without the diagnosis of HIV being considered
or a test offered. Whilst the prevalence of HIV in this age group remains
low, we would suggest that in all patients attending for assessment of
unintentional weight loss, a brief risk assessment be conducted and an HIV
test is offered which, at around ?3 per test, is potentially highly cost
effective.

1. McMinn J, Steel C, Bowman A. Investigation and management of
unintentional weight loss in older adults. BMJ 2011: 754 - 759

2. Palfreeman A, Fisher M, Ong E. Testing for HIV:concise guidance.
Clinical Medicine 2009; 9 :5:471-6.

3. Health Protection Agency Report: HIV in the United Kingdom: 2010
Report. Vol. 4 (47)
http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1287145367237

Simon Ellis, Specialty Trainee in Infectious Diseases, Royal Victoria
Infirmary, Newcastle upon Tyne.
Simon.ellis@nuth.nhs.uk

Competing interests: No competing interests

04 May 2011
Simon C Ellis
Specialty Trainee
Edmund L C Ong
Royal Victoria Infirmary, Newcastle upon Tyne