People living with HIV often wonder if their medications contribute to weight gain. As HIV treatment has improved health and life expectancy, changes in body weight have emerged as a consideration. Understanding this involves the complex interplay between the virus, medications, and broader lifestyle factors.
Understanding the Link to HIV Medications
Newer antiretroviral drugs, particularly integrase strand transfer inhibitors (INSTIs), have been associated with weight gain. Medications like dolutegravir and bictegravir, often combined with tenofovir alafenamide (TAF), show a greater propensity for weight increase. Studies report some people starting HIV treatment gain at least 10% of their body weight over one to two years, with the most significant gain often occurring in the first year.
Historically, older HIV medications were linked to weight loss or fat redistribution (lipodystrophy), such as fat loss from limbs or accumulation in the abdomen. The shift to newer, more effective, and generally better-tolerated regimens means current concerns focus on weight gain. Some older drugs, such as efavirenz and tenofovir disoproxil fumarate (TDF), may have even suppressed weight gain, making changes with newer medications more noticeable.
The exact reasons for weight gain with newer HIV medications are not fully understood, but several mechanisms are proposed. One theory suggests these drugs may interfere with the melanocortin signaling system, affecting appetite regulation. Another perspective is that effective medications allow the body to recover from chronic energy expenditure, leading to weight accumulation. However, the impact varies significantly among individuals, with factors like being female, of Black race, or having poorer health before treatment often associated with greater gain.
Other Factors Influencing Weight Changes
Weight gain in people with HIV isn’t solely due to medication side effects; other factors play a significant role. A primary contributor is the “return to health” effect. Effective antiretroviral therapy (ART) suppresses the virus and restores the immune system, so the body no longer expends vast energy fighting infection. This improved health can lead to a healthier appetite, better nutrient absorption, and a general restoration of weight to what it might have been without chronic HIV infection. For those underweight or experiencing wasting, this gain is a positive sign of recovery.
Beyond treatment and viral suppression, general lifestyle factors also influence weight. Diet, physical activity, and the natural aging process contribute to weight changes. As people with HIV live longer, healthier lives with effective treatment, they experience the same age-related metabolic shifts and lifestyle influences on weight as anyone else.
Co-existing health conditions or other medications can further impact weight. Various medical conditions and non-HIV medications cause weight gain or loss, adding complexity to understanding individual weight changes.
Strategies for Managing Weight
Managing weight with HIV involves a multi-faceted approach prioritizing overall health and effective HIV treatment. Central to any strategy are healthy lifestyle recommendations: balanced nutrition, regular physical activity, and adequate sleep. A balanced diet provides essential nutrients, while consistent exercise helps maintain a healthy weight, builds muscle, and improves cardiovascular health.
Open communication with healthcare providers, including HIV specialists and dietitians, is important. These professionals offer personalized advice tailored to individual needs and health status. A dietitian specializing in HIV care can assess body composition, provide guidance on dietary adjustments, and help create a nutrition plan supporting weight management and overall well-being.
While concerns about medication-related weight gain are valid, never stop or change HIV medication without consulting a doctor. The benefits of consistent, effective HIV treatment in suppressing the virus and maintaining long-term health far outweigh weight management challenges. In some cases, healthcare providers may explore medication adjustments if weight gain is significant and impacts health, but such decisions are made carefully, considering all aspects of a person’s health.