Obesity and Weight Gain in Persons with HIV

Abstract

Purpose of review: The proportion of overweight and obese persons with HIV (PWH) has increased since the introduction of antiretroviral therapy (ART). We aim to summarize recent literature on risks of weight gain, discuss adipose tissue changes in HIV and obesity, and synthesize current understanding of how excess adiposity and HIV contribute to metabolic complications.

Recent findings: Recent studies have implicated contemporary ART regimens, including use of integrase strand transfer inhibitors and tenofovir alafenamide, as a contributor to weight gain, though the mechanisms are unclear. Metabolic dysregulation is linked to ectopic fat and alterations in adipose immune cell populations that accompany HIV and obesity. These factors contribute to an increasing burden of metabolic diseases in the aging HIV population. Obesity compounds an increasing burden of metabolic disease among PWH, and understanding the role of fat partitioning and HIV- and ART-related adipose tissue dysfunction may guide prevention and treatment strategies.

Keywords: Adipose tissue; HIV; Inflammation; Metabolic disease; Obesity; Weight gain.

Figure 1.

Proposed model of obesity in persons with HIV (PWH). Contemporary antiretroviral therapy agents (principally integrase strand transfer inhibitors and tenofovir alafenamide), an obesogenic environment (high-fat diet and physical inactivity), shifting demographics, and an aging population predispose to obesity. Obesity in persons with HIV results in increased inflammation, increased ectopic lipid disposition, and alterations in lipid and glucose metabolism. This contributes to metabolic complications including diabetes mellitus, neurocognitive impairment, and hepatic disease. The link between obesity as measured by body mass index and cardiovascular disease is not completely understood.