HIV Wasting Syndrome

Published in Micronutrient Supplementation for Patients with HIV, written by Dr. Michael Todd Greene, Ed.D., M.S.,  R.D.N., September 2009.

(Part of course “Severe Malnutrition” available on this website.)

Cachexia affects over 5 million people in the U.S. It is the major cause of excessive weight loss in the setting of ongoing disease. Symptoms include a disproportionate loss of muscle mass. Some advanced disease states include cardiac cachexia, chronic renal failure, chronic obstructive pulmonary disease, anorexia-cachexia syndrome in cancer, rheumatoid arthritis and cachexia, aging and weight loss, and AIDS-related cachexia (wasting syndrome) (Morley, Thomas and Wilson, 2006).

The major cause of cachexia is cytokine excess. Cytokines produce the following etiology of anrexia, weight loss, cognitive dysfunction, anemia and frailty. Cytokines are cell-associated protiens produced as an inflammatory immune response. To combat the effects on the body, there are three areas recommended, nutritional support, orexigenic agents (hormonal therapy) (Morley et al., 2006), and physical exercise (Wolfe, 2006).

Elaboration of pro-inflammatory cytokines may be the major factor responsible for AIDS wasting. Cachexia associated with AIDS is highly predictive of death. AIDS wasting includes anorexia, depression, medications, coexisting infections and a variety of gastrointestinal diseases (Morley et al, 2006).

The question arises, how does someone exercise when having fever, diarrhea and no appetite? Can an exercise pill help increase muscle without physical work?

The benefits of physical exercise on general health make the identification of an orally active agent that mimics the potential effects of exercise on metabolic diseases worth studying. Certain micronutrients like Resveratrol. have endurance-enhancing affects but the exact metabolic targets are still not know. Testing the effect of pathway specific drugs on endurance of mice in a treadmill test was documented in August 2008 (Narkar et al., 2008). This study found that AICAR (AICAR 5-aminoimidazole-4-carbonoxyamide ribonucleoside) is a drug found to help change the physical composition of muscle transforming tissue from sugar-burning fast twitch fibers to fat-burning slow-twitch ones. Essentially producing the benefits of aerobic activity without the work in mice. AICAR has been found to be safe (Zarembo, 2008).

Next must read blog: Proposed clinical trial: HIV Wasting Syndrome.

Morley, J., Thomas, D. & Wilson, M. (2006) Cachexia: pathophysiology and clinical relevance. The American Journal of Clinical Nutrition, 83(4), 735-743.

Narkar, V., Downes, M., Yu, R., Embler. E., Wang, Y. Banayo, E., et al. (2008). AMPK and PPARo Agonists Are Exercise Mimetics. Cell, 134(8), 405-415.

Wolfe, R. (2006). The underappreciated role of muscle in health and disease. The American Journal of Clinical Nutrition, 475-82.

Zarembo, A. (2008, August 1). AICAR: Scientists say they’ve put exercise in a pill. Los Angeles Times.


Editorial Board: My Accomplishments


An open source international journal publication asked me to provide some information about my work. This comes at a time when I am on various Editorial Boards for scientific journals.

My Accomplishments

Dr. Michael Todd Greene, Ed.D., M.S., R.D.N.

Doctor of Education Registered Dietitian Nutritionist

Editorial Board of Recent Advancement in Food Science and Nutrition Research (ISSN 2638-9770)
a Open Source International Journal

Nutritional Science

Preceptor Coordinated Dietetic Program


Professional Baking

Baking Science and Technology

Large Scale Baking Assembly Line Management

Food Service Director

General Manager

Food Services Coordinator of all food operations

Startup opening of a standalone Starbucks café

Severe Malnutrition

Food Insecurity

Quality in hospitals

Reducing Hospital Admissions

Contracted with suppliers to budget for improved bottom line

Drill Down to discover

Graduation Speaker at Los Angeles Trade-Technical College

Life Changing, Leadership and Effective Management

Severe Malnutrition

Subject matter expert

Food Safety

Front Line Labor

Technical Trainings

Team with subordinate managers

Look up to but remain humble idol comraderies with co-workers

Outpatient Consultations

Outpatient Coaching

Physician matters and support

RD’s writing orders for Physicians to sign

Changed Nursing Initial Patient Screening, i.e., Nutritional Screening.

Implemented New Electronic Medical Record System

Paper Charting

Investigative savvy

Took on the administration of 401(k)

Investing proneness

RD Doctor of Education,Educational Psychology, Educational Leadership

  1. Gap: Motivation to Change One’s Health Behaviors
  2. Curriculum Development
  3. Online learning
  4. Scholarly Research Evidence Based, empirical, published, poster, presentation, peer review community
  5. Focus on low income, underprivileged, underrepresented populations of our society.
    1. LA Job Corps.
    2. Job Corps, Federal
    3. Secretary of Labor and the Labor Act
    4. Looked to use of technology today and made the most impact with research instruments
    5. Statistics and Quantitative vs. Trends, Observations and Motivation studies
    6. Food Insecurity
    7. Worked with Government agencies, i.e. Dept. of Public Social Services, Consulate General’s, LA County Community provided resources, i.e., LA Food Bank,
    8. Logic studies
    9. Network for a Healthy California
    10. Presented to District wide (Road Tour) to School Nurses of LA Unified to look for signs of food insecurity and what can be done by you, a School Nurse.
    11. Kaiser Permanente, Westside and Inglewood Group Teaching
      1. Different audiences, i.e., school children, siblings and parents of family
      2. Individual Consultations as Physician Referrals

Service Provider

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Have you or your loved one experiencing any of these?

Ask About Your Nutrition?

If you are a hospitalized adult in the U.S. you are more likely to be malnourished than not. Up to 50% of all hospitalized adults are malnourished according to many research projects.

The present gap and educational opportunity to help people in their lives.

We consult hospital systems to help improve the problems of nutritional diagnosis, Severe Malnutrition and Non-Severe Malnutrition. Helping facilities increase reimbursement revenue through documentation and coding, improving the role of Registered Dietitians by physical assessment with medical nutrition therapy, and for families by helping to understand and know what to do.

My efforts is to the end goal and to be an advocate the improved nutritional status for the underprivileged the undernourished, the underdogs of this world, as well as, did we mention food insecurity.