LIVING WITH HIV

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People living with HIV often experience changes in weight, which can involve either weight loss or weight gain.[1,2] Unintentional or sudden weight changes may result from different things, such as HIV itself, HIV treatment side effects, lifestyle changes, or other underlying causes.[1,2] 

Weight fluctuations can impact your health, so it’s key for anyone living with HIV to discuss any weight changes with their doctor.[1,2]

HIV AND WEIGHT GAIN

Weight gain can be normal and positive for people living with HIV, but excessive weight gain can have a negative impact on health. This includes reduced well-being, a lower quality of life, and an increased risk of health conditions, such as diabetes, cardiovascular disease, and liver disease.[3,4]

Causes of weight gain in HIV

There can be several different causes for weight gain in people living with HIV. This includes medication side effects, excess calorie intake, a high-fat diet, reduced physical activity, mental health, other health conditions, ageing populations, and beginning antiretroviral therapy (ART) for HIV.[4]

Weight gain is common when people start ART.[2] People living with untreated HIV can experience weight loss, so it’s common for them to gain weight when beginning ART – this may be described as a ‘return to health.’[2,5] However, in recent years, it has been found that weight gain after starting HIV treatment can become excessive, and higher rates of obesity have been found in people living with HIV after starting ART.[2–4]

The exact causes of weight gain after starting ART are not fully understood, but are thought to be linked to how ART reduces the amount of energy required by the body to fight the virus.[6] Additionally, ART reduces inflammation, which can increase appetite and nutrient absorption, perhaps further contributing to weight gain.[7–9]

Studies have shown that women living with HIV who begin ART are more likely to experience weight gain than men.[2,4] Likewise, individuals in poorer health before starting ART also face a higher likelihood of weight gain.[10]

According to studies, it has been shown that certain types of antiretroviral (ARV) drugs, such as integrase inhibitors and tenofovir alafenamide (TAF), are more likely to cause weight gain compared to other ARVs.[2–4,10]

HIV AND WEIGHT LOSS

People living with HIV may also experience weight loss, however, it is now less common than it was in the past due to advancements in treatment.[1]

Causes of unintentional weight loss in HIV

Weight loss in HIV can occur because of a variety of factors: 

Opportunistic infections: Opportunistic infections are infections that occur more often or are more serious in people with weakened immune systems, such as people living with HIV.[11] Two common OIs in people living with HIV are oral candidiasis and tuberculosis (TB), both of which can cause weight loss.[11-13]

Low food intake and nutrient absorption: Low food intake can happen for various reasons, including:[1]

  • Conditions or infections that make it hard to chew and/or swallow.
  • Mental health conditions that cause a loss of appetite.

Additionally, poor absorption of nutrients can also occur due to diarrhoea, and HIV-related digestive issues, which can lead to weight loss.[1]

Metabolism and hormones: People living with HIV who are untreated use more energy and burn more calories while at rest compared to HIV-negative individuals. This can lead to weight loss.[1] HIV can also affect the production of hormones, such as testosterone, which can lead to a loss of muscle mass in people living with HIV.[1]

Medication side effects: A known side effect of some first-generation ARV drugs is a condition called lipodystrophy, which is a disorder that affects fat storage or causes fat wasting.[14] This condition results in weight loss.[15] This is no longer very common with new treatments. Currently, a more common side effect of ART is weight gain. However, some older drugs may still be in use in lower-resource countries.[16]

HOW TO PREVENT WEIGHT CHANGES IN HIV

Maintaining a balanced diet is key to ensuring an adequate calorie intake and a healthy body weight. Depending on the individual situation, someone living with HIV may be advised to eat a higher-calorie, protein-rich diet, or calorie restriction may be recommended to support weight loss.[4,17]

It is important to consult your doctor to determine the recommended daily calorie intake for maintaining a healthy balance.[2]

Regular exercise can also help with any weight changes. Exercise can promote weight loss and weight gain - with strength-building activities supporting increased muscle gain.[18]

Taking your HIV medications as prescribed, staying in regular contact with your healthcare provider, and making overall healthy lifestyle choices will further reduce your risk of excessive weight loss or weight gain.[1,17]

Abbreviations:

ART, antiretroviral therapy; ARV, antiretroviral; BMI, body mass index; CVD, cardiovascular disease; GLP-1, glucagon-like peptide 1; OI, opportunistic infection; REE, resting energy expenditure; TB, tuberculosis.

References:

  1. Badowski ME, Perez SE. Clinical utility of dronabinol in the treatment of weight loss associated with HIV and AIDS. HIV AIDS (Auckl). 2016 Feb 10;8:37–45. doi:https://doi.org/10.2147/hiv.s81420
  2. Bares SH, Wu X, Tassiopoulos K et al. Weight gain after antiretroviral therapy initiation and subsequent risk of metabolic and cardiovascular disease. Clin Infect Dis. 2024 Feb 17;78(2):395–401. doi:https://doi.org/10.1093/cid/ciad545
  3. Ruderman SA, Crane HM, Nance RM et al. Brief report: Weight gain following ART initiation in ART-naïve people living with HIV in the current treatment era. J Acquir Immune Defic Syndr. 2021 Mar 1;86(3):339–43. doi:https://doi.org/10.1097/qai.0000000000002556
  4. ailin SS, Gabriel CL, Wanjalla CN, Koethe JR. Obesity and weight gain in persons with HIV. Curr HIV/AIDS Rep. 2020 Apr 18;17(2):138–50. doi:https://doi.org/10.1007/s11904-020-00483-5
  5. WHO. HIV and AIDS. 2024. Available from: https://www.who.int/news-room/fact-sheets/detail/hiv-aids [Accessed: March 2025]
  6. Kosmiski L. Energy expenditure in HIV infection. Am J Clin Nutr. 2011 Dec;94(6):1677S – 1682S. doi: 10.3945/ajcn.111.012625
  7. Chandiwana NC, Siedner MJ, Marconi VC et al. Weight gain after HIV therapy initiation: Pathophysiology and implications. J Clin Endocrinol Metab. 2024 Jan 18;109(2):e478–87. doi: 10.1210/clinem/dgad411
  8. Sax PE, Erlandson KM, Lake JE et al. Weight gain following initiation of antiretroviral therapy: Risk factors in randomized comparative clinical trials. Clin Infect Dis. 2020 Sep 12;71(6):1379–89. doi: 10.1093/cid/ciz999
  9. Alebel A, Demant D, Petrucka PM et al. Weight change after antiretroviral therapy initiation among adults living with HIV in Northwest Ethiopia: a longitudinal data analysis. BMJ Open. 2022 Feb 1;12(2):e055266. doi: 10.1136/bmjopen-2021-055266
  10. Siddiqui J, Samuel SK, Hayward B et al. HIV-associated wasting prevalence in the era of modern antiretroviral therapy. AIDS. 2022 Jan 1;36(1):127–35. doi:https://doi.org/10.1097/qad.0000000000003096
  11. NIH. What is an Opportunistic Infection? 2021. Available from: https://hivinfo.nih.gov/understanding-hiv/fact-sheets/what-opportunistic-infection [Accessed: March 2025]
  12. NHS. Tuberculosis. 2023. Available from https://www.nhs.uk/conditions/tuberculosis-tb/ [Accessed: October 2025]
  13. NIH. Overview: Oral thrush 2022. Available from https://www.ncbi.nlm.nih.gov/books/NBK367586/ [Accessed: October 2025]
  14. NIH. Guzman N, Vijayan V. HIV-associated Lipodystrophy. 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493183/ [Accessed: March 2025]
  15. Verhaegen AA, Van Gaal LF. Drugs affecting body weight, body fat distribution, and metabolic function-mechanisms and possible therapeutic or preventive measures: An update. Curr Obes Rep. 2021 Mar 5;10(1):1–13. doi:https://doi.org/10.1007/s13679-020-00419-5
  16. The Well Project. Nutrition and HIV. 2024. Available from: https://www.thewellproject.org/hiv-information/nutrition-and-hiv [Accessed: March 2025]
  17. US Department of Veteran Affairs. HIV wasting syndrome. 2019. Available from: https://www.hiv.va.gov/patient/diagnosis/OI-wasting-syndrome.asp [Accessed: March 2025]

NP-GBL-HVX-COCO-250016 November 2025

Reporting of side effects

If you get any side effects, talk to your doctor, pharmacist, or nurse. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the GSK Reporting Tool link https://gsk.public.reportum.com/. By reporting side effects, you can help provide more information on the safety of this medicine.

If you are from outside the UK, you can report adverse events to GSK/ ViiV by selecting your region and market, here.