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Updated: Jul 23, 2025

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Weight Gain After HIV Therapy Initiation: Pathophysiology and Implications.

Nomathemba C Chandiwana1, Mark J Siedner2, Vincent C Marconi3

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Summary

Modern HIV therapy (ART) improves life expectancy but can cause weight gain and obesity in people living with HIV (PLWH), especially Black individuals and women. This review explores causes, implications, and interventions for ART-associated weight gain.

Keywords:
HIVantiretroviral treatmentmetabolic consequencesobesityweight gain

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Area of Science:

  • Infectious Diseases
  • Endocrinology
  • Metabolic Disorders

Background:

  • Modern antiretroviral therapy (ART) has transformed HIV/AIDS management, leading to near-normal life expectancy for people living with HIV (PLWH).
  • Paradoxically, weight gain and obesity have emerged as significant challenges for PLWH on ART, contrasting with the historical
  • slim disease
  • associated with early HIV/AIDS.
  • This phenomenon disproportionately affects Black individuals, women, and those with advanced immunodeficiency at treatment initiation.

Conclusions:

  • Weight gain and obesity are significant, recently recognized complications of modern ART in PLWH.
  • Understanding the pathophysiology is crucial for managing metabolic comorbidities.
  • Further research is needed to develop effective interventions, including novel antiobesity agents, for PLWH experiencing weight gain on ART.