Obesity and Weight Management in HIV: Epidemiology, Complications, and Emerging Treatments

People living with HIV (PLWH) on contemporary antiretroviral therapy experience high rates of overweight/obesity, which predisposes to cardiometabolic disease and multiple other conditions with negative health consequences in this aging population. We aim to summarize the epidemiology and pathophysiology of obesity in PLWH and review recent advances in the therapeutic management of obesity.

The prevalence of overweight/obesity in PLWH mirrors long-standing trends in the general population. Obesity and weight gain have a complex, multifactorial pathogenesis and directly mediate detrimental metabolic changes that are common in PLWH. While lifestyle changes are important, surgical weight loss and recent advances in medical therapeutics are more effective at reducing obesity and obesity-related complications. Obesity in PLWH substantially increases the risk for cardiometabolic complications and poor health outcomes. Surgical and medical weight loss interventions are effective treatments to reduce obesity and obesity-related complications, though further research in PLWH is needed to define optimal management.