Population health and epidemiologic trends in weight gain among people with HIV

The epidemiology of weight among people with HIV (PWH) has shifted from wasting to overweight and obesity. This review summarizes population trends in weight, antiretroviral therapy (ART)-associated weight trajectories, subgroup heterogeneity, and cardiometabolic consequences of weight gain among PWH.

Weight gain after ART initiation is common and occurs against a background of secular increases in obesity prevalence. Greater gains are often observed with contemporary integrase strand transfer inhibitor (INSTI)-containing and tenofovir alafenamide (TAF)-containing regimens, although interpretation is complicated by return-to-health and the weight-suppressive effects of older regimens (efavirenz and tenofovir disoproxil fumarate). Weight changes after ART switch are usually modest, and discontinuing INSTI or TAF rarely reverses established gain. Black women and individuals with advanced HIV disease experience greater gains, and substantial early increases in weight have been associated with diabetes, metabolic syndrome, hypertension, and dyslipidemia.

Weight gain among PWH is heterogeneous and should be interpreted in the context of baseline nutritional status, ART exposure, and population setting. Future studies should identify which patterns of weight gain predict adverse clinical outcomes and evaluate interventions that reduce metabolic risk.