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. Simon Collins

    Hi DeeJay, several recent studies have suggested that integrase inhibitors might be linked to weight gain. This means that using alternative to Triumeq and Biktarvy might be worth trying. If your viral load was undetectable when you stopped using Atripla, you could try going back to that combination. For links about this please use these two:
    http://viruseradication.com/final_article_files/1546499314jve_5_1_08_Hill_rev.pdf (PDF)
    As this possible side effect has only recently been reported there is even less information about how to manage this complication. Diet advice and exercise from qualified experts might also help.

  2. DeeJay

    I believe it is the medicine when I was first on atripla I didn’t gain weight but when these new medicine came out, complera I gain 20 pounds and it balance out, then trimeuq, gain another 20 pounds, then biktarvy. Another 20 pounds I tried dieting and exercising boy that was a joke. I even tried eating 600-1000 calories a day. No a pound loss, but I have loss body fat, clothes fit comfortably but no pounds shed.

  3. Roy Trevelion

    Hi Lisa,

    It’s good that you’re back to normal size. But what does your doctor say about it? Did they say you could try and change to different meds to see if it made a difference?

    Can you talk to your doctor about taking other HIV meds?

  4. Lisa

    To be honest now i know the truth i was size 14but now i wear size 16to18abd ny kg is 94since i take this HIV medicine i gain weight to much and my heart struggle to run fast i stop take medication now im back to my normal size i choose to ear health and look after ny self more as far i see medication make wase until thry give another medicine

  5. Lisa Thorley

    Hi Hilary,

    Weight loss can be due to a lot of reasons. Though medication could be contributing to this, a rise of 23 kilos is unlikely to be related to medication alone. How is your lifestyle?Over what period have you put this weight on. Was your CD4 low when you started meds?

  6. Hilary

    I am also very depressed because I am picking a lot of weight I was 95 Kg when I started now I am sitting on 117 and this is really an issue for me. Please help

  7. Lisa Thorley

    Hi JS,

    Over what period of time have you gained this weight? Have you discussed this with a healthcare professional? A 20 kilo weight gain won’t be due to being positive.

  8. JS

    I gained so much weight as well… almost 20kg. From 62 to 82Kg…

  9. Lisa Thorley

    Hi Fancy,

    Weight gain can be due to a lot of things. How’s your lifestyle?

  10. Fancy

    Wen u started on arv I was 80kg now 93 kg and it’s so depressing I tried everything nothing works


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