Weight management in people with HIV

Excess weight gain in people with HIV is now recognised as a common risk associated with the use of guideline-recommended antiretroviral therapy, such that nearly 50% of people with HIV are living with comorbid obesity. Weight gain and clinical obesity exacerbate cardiovascular-kidney-metabolic health complications in this population and chronic weight management strategies that reduce these risks are now an urgent priority. Behavioural interventions can be offered to improve diet and increase physical activity, including increasing protein intake and promoting regular physical activity. Additionally, there is a growing body of evidence to support the use of GLP-1 receptor agonist therapies in people with HIV, along with a historical literature showing the efficacy of tesamorelin; however, there are sparse data to direct the use of other approved obesity management medicines specific to this population. Finally, bariatric surgical interventions are suggested to be safe and efficacious for those with chronic HIV infection and comorbid obesity. This Series paper identifies a range of key evidence gaps and research priorities for obesity management in people with HIV, including a lack of trials of GLP-1 therapies in people with HIV powered to key clinical outcomes, such as major adverse cardiovascular events and body composition endpoints, implementation science to define models of care, and research on the heterogeneities in clinical outcomes of obesity treatment by sex.