Weight changes on ART

Balanced weighting scales

Changes in body weight

Over the last few years, researchers have spent more time looking at whether changes in weight is a side effect of some HIV drugs.

The is mainly about whether integrase inhibitors cause some people to put on weight, but several other drugs are also related.

The findings so far shouldn’t cause most people to worry about weight changes when choosing ART. Using an integrase inhibitor in your first treatment is rightly recommended in all treatment guidelines. These drugs are highly effective and easy to take.

But it is important to record your weight when starting treatment, and to then include your weight with routine monitoring to know whether you are affected.

The earlier you know about any significant weight changes the easier it will be to manage this. This will usually involve either diet and exercise or to change treatment. Changing treatment has not yet been well-studied to see whether this will work.

Several other things are important.

Weight changes were not reported as a side effect when integrase inhibitors were first approved. Also, nearly everyone puts on some weight in the first six months of treatment, especially if viral load was high. This is healthy, because you body is no longer using energy to fight HIV.

Then, in 2019, the ADVANCE study in South Africa, reported unexpectedly higher increases in weight (average 6 kg) with dolutegravir after one year that was higher still if people also used TAF. It was also significantly higher in women compared to men.

The weight increases have also continued in year’s two and three of the study. Although few people changed treatment, the increases in some people are significant enough to worry about other serious weight-related complications, such as heart disease and diabetes. This can make ways to lose weight more important.

So far, the most significant increases have been reported in African women, so both sex and ethnicity are important. One reason that weight changes were perhaps not reported earlier is because participants in research studies are still largely white. cisgender gay men.

The ADVANCE study showed the importance of running studies in more diverse populations who represent the range of people who will use these drugs globally.

Research is still ongoing to explain the findings in the ADVANCE study. This needs to allows for weight increases in the general population and also as we age (as we become less active). We also need to find out how to manage or reverse any weight gain.

The findings are likely to be true though, at least in South Africa, because ADVANCE was a large randomised study. It also compared dolutegravir to efavirenz and compared TAF to the earlier version of tenofovir (TD). Although people using TAF had increased weight compared to TD, this is because TD slightly reduces weight.

Specialist advice on the best way for diet and exercise to help with weight loss is the main response for managing significant weight gain.

Bariatric surgery has been reported as both safe and effective in people iving with HIV.

  • Zino L et al. Outcomes of bariatric surgery in people with HIV: a retrospective analysis from ATHENA cohort, Clinical Infectious Diseases, 2023; ciad404.

Treatment with GLP-1 analogues such as semaglutide is now recommended in the general population and so could be considered Currently there is no data in people living with HIV.

Other body changes

Other changes in body fat called lipodystrophy were only really linked to the early HIV meds. This included fat loss (to the face, arms and legs) and fat gain (to the stomach, breasts and at the back of the neck).

Information on these side effects is included later in this guide at these links.

Metabolic changes

Metabolic changes can occur with many HIV drugs and combinations, but can also be caused by lifestyle factors including diet and lack of exercise.

Information on these side effects is included later in this guide at these links.

Routine monitoring by your HIV clinic, with blood or urine tests, look for these possible side effects.

Diet, exercise, changing treatment or using lipid-lowering drugs can all help.

If you are worried, your doctor should take your concerns seriously and act on them.

Last updated: 1 March 2023.