Q and A


Why have I gained so much weight?

I have been on treatment for six months. I am taking Truvada, ritonovir and darunavir. My viral load is 164 and CD4% is 24%.

I have not changed my diet or activity but my weight has increased from 76kg to 91kg. Why have I gained such a dramatic amount of weight that I can’t shift?


Thank you for your question.

It is difficult for me to answer your question accurately without further information.

For example, I need to know something about your current  age, height and your ‘normal’ weight before you were positive in 2008. Also, where on your body you are putting on weight e.g. around your stomach, chest and back or elsewhere.

As a general rule, most people put on weight when they start HIV treatment (ART).

On average this ipeople gain 5-10% of their pre-ART body weight. This is a good thing and is realted to a return to better health. It is due to your body having to work really hard to fight the infection before ART when your viral load was still high.

Once ART starts to reduce your viral load, your body no longer needs as much energy fighting HIV. Even if you are not eating more food, the rate at which you burn it has changed and this could mean there is some weight gain.

However, fat accumulation is also a well documented side effect (called lipodystrophy) that was reported with nearly every combination. This is especailly the case when ART was first developed.

Please ask your doctor whether your symptoms are more likely to be a side effect than normal ‘return-to-health’ weight gain.

Lipodystrophy involves fat accumulating in the abdomen (stomach), breasts, shoulders, neck and is sometimes exaggerated by fat loss from the arms, legs, buttocks and face.

Although this usually only happens slowly over several years, there have also been reports of it occuring more quickly in some people.

More information on fat accumulation.

As we get older it gets more difficult to loose the weight we gain. It is also harder to go back to exercise.

This answer was updated in January 2016 from a question first posted on 8 July 2010.


  1. Roy Trevelion

    Hi Daniel,

    It’s good that you’ve started Atroiza. However, many HIV positive people lose weight if they’re not taking HIV treatment. That’s because your body is using its energy to fight HIV and possibly other infections.

    Atroiza can help to get your viral load down quickly. And this gives your immune system the chance to recover. Here’s a link to ART in Pictures that shows what happens to viral load and CD4 counts when starting ART.

  2. Daniel

    I am male 42 I am now 2 weeks on atroiza I have lost weight and is possible to regain and am fatigued weight loss is much my concern

  3. Lisa Thorley

    Hi Okuhle,

    What ARVs are you taking?

  4. Okuhle

    Since I started arvs I’m getting hungry all the time it’s normal ?

  5. Lisa Thorley

    Hi Christmas,

    Weight gain is common when people are on ARVs. Some people gain a little weight whilst others can gain a lot. When you were diagnosed what was your viral load and CD4 count? Have you followed the advice in the above post?

  6. Christmas

    I started trivanze two yeasr ago. Was weighing 75kg waist 32 and height 1.65m. After started this medication i am now weighing 92.5 and waist of 36. M exercising but nothing happened. My doctor gave me Relislim tables but there is still nothing. Have been to Dietician and there is nothing wrong with my eating plan. Pls assist i want my weight back so badly.

  7. Lisa Thorley

    Hi Sammy,

    Weight gain with modern ARVs and especially those that commonly prescribed in the UK aren’t known to cause weight gain. This doesn’t however mean that its not possible.

    How much weight have you gained, and over what period of time? What;s your lifestyle like?

  8. Sammy

    I am 32 Male and I am gaining weight like crazy. I go to the gym and work out but nothing is working . I am on medication and have spoken to my hiv doctors about it … they are no help at all. I then wanted to try taking alli tablets to help with some weight loss and was told I can’t as they Interfere with my tablets… the doctors told me I’m not fat enough to get help from the nhs . If I don’t get help soon I am getting suicidal

  9. Rebecca McDowall

    Hi Lolo,

    It’s great that you’re trying to do some exercise. It’s also important to eat healthily if you want to lose weight. You can read about diet and exercise in our side effects guide.

    It’s also worth talking to your doctor about your weight. If this weight gain is a side effect of treatment it may be possible to change to a different combination.

    It’s fine to take all your tablets together.

  10. lolo

    I also experience more or less the same predicament of gaining too much weight and since I started treatment I’m always hungry which leads me to eating more.

    I’m taking nevirapine,tenofovir and lamivudine,and this makes me very lazy to do house chores. I have started exercising by taking a 45 min walk at least 4 to 5 times a week but I get tired too quickly.

    I’m in SA,I weigh 115kg and I’m worried, but I’m not experiencing an limb disfigurement. I’ve been a year now on ARVs.

    Another thing I’m taking my 5 tablets once a day,in the evening,how safe is that?


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