Weight Gain While Treating HIV: Why It Happens

People living with HIV may experience weight gain due to several factors. Here are some common reasons for weight gain during HIV treatment:

Antiretroviral therapy (ART): Many ART medications, particularly older drugs like protease inhibitors and certain nucleoside reverse transcriptase inhibitors (NRTIs), can cause changes in body composition and fat distribution. Some of these medications increase appetite and may slow down metabolism, which can lead to weight gain.

Immune reconstitution inflammatory syndrome (IRIS): IRIS is a condition that can occur when the immune system starts to recover after starting ART. This inflammatory response can lead to weight gain due to fluid retention and tissue inflammation.

Changes in diet and physical activity: Starting ART can improve energy levels and overall well-being, which may lead to changes in eating habits and physical activity levels. People may become less physically active and consume more food, resulting in weight gain.

Cushing's syndrome: A rare but serious complication of ART is Cushing's syndrome, which is caused by elevated levels of the hormone cortisol. Cushing's syndrome can lead to weight gain, often in the face and trunk, and other symptoms such as high blood pressure, diabetes, and muscle weakness.

Opportunistic infections: Before ART became widely available, HIV often led to severe infections and malnutrition. Today, people with well-controlled HIV through ART usually do not experience severe infections. As a result, they may gain weight as their overall health improves.

Emotional stress and depression: Living with HIV can be emotionally stressful and may lead to depression. Stress and depression can disrupt eating habits and physical activity patterns, potentially contributing to weight gain.

Medications for other conditions: Some medications used to treat other conditions, such as corticosteroids or antidepressants, can also cause weight gain.

It's important for people living with HIV to have regular check-ins with their healthcare providers to monitor their weight and overall health. If unexplained weight gain or sudden changes in body composition occur, the healthcare provider can investigate the underlying cause and recommend appropriate management strategies.