Cardiometabolic risk

Combination Antiretroviral Therapy Is Associated With Weight Gain, Especially After 2 Years of Treatment

In patients with HIV who are taking combination antiretroviral therapy (ART), tenofovir alafenamide increases the risk for weight gain, especially after 2 years of therapy, according to new data presented at IDWeek 2021. The mean percentage gain in weight was greater when the combination also included an integrase strand transfer inhibitor.

To explore factors associated with gaining weight in patients with HIV receiving ART, Ohio State University researchers retrospectively studied a cohort of 870 adult patients with HIV who were seen for at least 3 months at the Wexner Medical Center Infectious Diseases Clinic from 2015 to 2019. Most study patients were male (84%), 29% were Blank, and 66% had a body mass index of at least 25 kg/m2.

The study’s primary outcome was percentage weight change during the follow-up period, and its secondary outcome was odds of gaining more than 5 kg. The researchers also modeled the effects of ART combinations and self-reported behaviors on these outcomes by using mixed-effect linear and logistic regression analysis.

During a mean follow-up period of nearly 2 years, mean percentage weight gain in the study population was 2%, and the odds of gaining more than 5 kg was 0.3
(p < 0.001, for both outcomes). Increasing age and improved diet were associated with a percentage decrease in weight during the study period (p < 0.001, for both). Improved diet was also associated with a lower chance of a weight gain of more than 5 kg (odds ratio, 0.7; 95% CI, 0.5 to 0.97; p = 0.03).

Results of regression modeling indicated that taking combination therapy that included tenofovir alafenamide was a key factor associated with a percentage gain in weight, and this weight gain percentage was greater when the regimen also included an integrase strand transfer inhibitor.

“This data highlights the influential role of diet in [people with HIV] at risk of ART-associated weight gain,” concluded presenting author Yesha Patel, MD.

—Ellen Kurek


Patel Y, Doshi A, Levesque A, et al.  Improvement in diet attenuates antiretroviral therapy (ART) associated weight gain in persons with human immunodeficiency virus (PWH). Paper presented at: IDWeek 2021; September 29-October 3, 2021; Virtual.