Which Hiv Drugs Cause Weight Gain
Some HIV drugs are more likely to cause weight gain than others. Older drugs like the nucleoside reverse transcriptase inhibitors and non-nucleoside transcriptase inhibitors generally aren’t linked to weight gain.
These medications include:
One type of NRTI, tenofovir alafenamide, does seem to cause weight gain. It is one of the drugs in the combination therapy Biktarvy.
Protease inhibitors like atazanavir , darunavir , and tipranavir may cause weight gain.
A newer group of HIV medications called integrase strand transfer inhibitors are the ones most likely to make you gain weight. These drugs include:
How much weight you put on during treatment depends on the specific drug you take. In one study, people who took tenofovir alafenamide for 2 years gained an average of 9 pounds. Those who took Ziagen gained an average of 7 pounds. But people who took Retrovir gained less than 1 pound over the same amount of time.
Why Do People Gain Weight
The reasons for weight gain after starting treatment are unclear. Several explanations have been proposed.
One explanation is that weight gain is a result of immune recovery. Long-term viral infection depletes fat stores. When people recover from famine or severe infection, body fat stores are replenished. Weight gain may represent a restoration of weight to what it might have been, had the person not been living with HIV for a number of years . However, weight gain may overshoot in people more prone to obesity for dietary or genetic reasons. Studies show that people with more advanced HIV disease gain more weight, as do people who were underweight before starting treatment.
Another theory is that integrase inhibitors might cause weight gain through effects on the hormonal system which governs appetite regulation, leading to increased food intake . But a laboratory study by one of the drugs manufacturers found that the amount of any integrase inhibitor needed to interfere with the normal activity of this system would be far greater than the drug concentrations achieved from normal doses of integrase inhibitors .
Furthermore, one study found that people did not eat more after starting treatment nor did they experience a reduction in metabolic rate . Another study found that substantial weight gain after four years of treatment was largely attributable to higher pre-treatment weight and lower physical activity, not increased food intake .
The Impact Of Weight Gain During Hiv Treatment On Risk Of Pre
- 1St George Clinical School, University of New South Wales, Sydney, NSW, Australia
- 2Department of Endocrinology, St Vincent’s Hospital, Sydney, NSW, Australia
- 3Diabetes and Metabolism Program, Garvan Institute of Medical Research, Sydney, NSW, Australia
- 4St Vincent’s Clinical School, University of New South Wales, Sydney, NSW, Australia
First recognised as a disease in 1981 , HIV-infection and acquired immunodeficiency syndrome is a global epidemic. Data from The Joint United Nations Programme on HIV/AIDS shows that HIV-infection currently affects 36.7 million people worldwide and has caused 35 million deaths . HIV-infection was initially a rapidly fatal condition due to virus-induced immunosuppression and opportunistic infections. Since the introduction of combined anti-retroviral therapy in the mid-1990s, the narrative of the natural history of HIV-infection has been re-written: effective virological suppression has dramatically improved prognosis and survival evidenced by declining rates of AIDS-related deaths . In nations where cART is readily accessible, HIV-infection is now commonly considered a chronic, treatable illness with life expectancy approaching that of the general population .
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Nutrition And Exercise When You Have Hiv
Good nutrition and exercise can improve your health and slow the progression of your HIV infection. Eating well and working out can maintain your energy level and reduce your risk of acute infection.
You might have trouble eating if you have sores in your mouth, diarrhea, nausea, or just a poor appetite . If you have trouble eating or exercising, talk to your doctor.
If you are receiving treatment for HIV, you should follow regular dietary and exercise guidelines, which including many of the ideas below. If you condition advances, you may need to take the steps recommended here that will optimize your health.
The Impact Of Weight Gain On Mortality Risk In Cart
Obesity and weight gain are associated with increased risk of all-cause mortality in the general population . It is unclear whether this translates to people living with HIV-infection however, given that greater weight during HIV treatment has been associated with better disease outcomes and survival and weight loss has been described as a predictor of mortality . These apparent paradoxes may be clarified by dissecting out the influences of being underweight or cachectic, the influence of weight status per se and considering the timing of cART-initiation in the natural history of HIV-infection and AIDS.
The few studies supporting survival benefits of weight gain during HIV treatment have not, however, established a cause-effect relationship. Therefore, it is unclear whether weight gain itself provides survival benefits or is simply a reflection of better social determinants of health outcomes or a manifestation of a return to health phenomenon , as described earlier.
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The Metabolic Complications Of Rising Adiposity Trends In Hiv Treatment
The enthusiasm over the improvement in HIV-associated mortality following the introduction of cART has, however, been partly diluted with concerns of cART-associated metabolic complications, including hyperlipidaemia, insulin resistance, and lipodystrophy, which accelerate the onset of type 2 diabetes mellitus and atherothrombotic cardiovascular disease . Lipodystrophy is characterised by peripheral subcutaneous lipoatrophy and central/abdominal lipohypertrophy and has been shown to increase risk of diabetes and myocardial infarction in HIV-treated populations. Whilst earlier cART medications such as nucleoside reverse transcriptase inhibitors and first-generation protease inhibitors were associated with the most clinically evident lipoatrophy and high rates of premature diabetes, longer-term data are lacking on the metabolic consequences of more modern regimens.
Symptoms Of Acute Hiv
Some but not all people experience flu-like symptoms during the acute HIV infection phase. Usually lasting just a few days, symptoms include fever, chills, night sweats and even rash. Because these symptoms resemble those of other common infections, it is easy for this stage to pass undetected and leave its victims unsuspecting. If you have recently engaged in high-risk behaviors and are experiencing flu-like symptoms, it is important to get an HIV test. Not only can early HIV detection and intervention save your life, it can save the lives of others, as the risk for transmitting HIV is highest during the acute stage.
- Some but not all people experience flu-like symptoms during the acute HIV infection phase.
- Because these symptoms resemble those of other common infections, it is easy for this stage to pass undetected and leave its victims unsuspecting.
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Paradigm Shifts In Cart
Recently, global efforts have focussed on increasing access to and early initiation of cART to prevent AIDS-related deaths and HIV transmission . Over the last 10 years, the World Health Organisation has recommended earlier cART-initiation based on CD4+ T-lymphocyte counts falling below progressively higher thresholds: 200 cells/L in 2006 , 350 cells/L in 2009 , and 500 cells/L in 2013 . Global strategies to eradicate HIV transmission led the WHO in 2015 to recommend cART-initiation at HIV diagnosis regardless of CD4+ T-lymphocyte counts . Further, UNAIDS launched the 90-90-90 targets in 2014 aiming to end the AIDS epidemic by 2030: 90% of people living with HIV-infection knowing their status, 90% receiving sustained cART and 90% of cART-recipients achieving viral suppression by 2020 . It is estimated that if these targets are met by 2020, the number of cART-recipients worldwide would increase from 20.9 million to 30 million .
When Hiv Makes You Lose Weight
Unwanted weight loss related to HIV is less common than it once was, but it still happens. HIV itself — as well as related problems and treatments — can cause it. It’s more common in people with untreated or severe disease, an infection, or a high viral load, which is a high concentration of the virus in the blood.
When you have HIV, things that can cause you to lose weight include:
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Hiv/aids Reduces The Absorption Of Food
Food, once eaten, is broken down by digestion into nutrients. These nutrients pass through the gut walls into the bloodstream and are transported to the organs and tissues in the body where they are needed. One of the consequences of HIV and other infections is that since the gut wall is damaged, food does not pass through properly and is consequently not absorbed.
Diarrhoea is a common occurrence in people with HIV/AIDS. When a person has diarrhoea the food passes through the gut so quickly that it is not properly digested and fewer nutrients are absorbed.
Reduced food intake and absorption lead to weight loss and malnutrition.
Anabolic Steroids Exercise And Growth Hormone Stimulators
The use of anabolic steroids combined with exercise can help boost lean tissue, including muscle size, but this combination does not significantly improve fat loss or accumulation. In studies of people using the steroids oxymetholone or nandrolone, muscle size increased but there were no reductions in accumulated fat, and there were worrisome decreases in HDL cholesterol . In those using oxymetholone, there were also increases in liver enzymes, indicating possible toxicity to the liver. Neither oxymetholone nor nandrolone is available by prescription in Canada.
Exercise alone has generally been shown to have either a small benefit or no benefit in terms of losing the fat associated with lipodystrophy. But exercise does have many other benefits, including boosting cardiovascular fitness, mental well-being and self-esteem.
The synthetic growth hormone-releasing medication called tesamorelin is available in Canada. It is approved for the treatment of HIV-associated fat accumulation. Clinical trials showed that Egrifta reduced visceral gut fat, but also that it would have to be used long-term when the drug was stopped, gut fat returned. The drug is expensive and used only by people with private drug insurance coverage. The cost of this drug is not subsidized by provincial/territorial drug formularies.
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Why Do Hiv Drugs Cause Weight Gain
Weight gain is a common side effect of antiretroviral therapy . On average, people put on about 4 pounds during the first 2 years of their treatment. Most of that gain happens in the first year.
About 1 in 5 people who were at a healthy weight when they were diagnosed with HIV become overweight within 3 years after going on these drugs.
Scientists aren’t sure why HIV medications cause weight gain. One possible reason is that they work. When you have HIV, your body constantly burns calories fighting infections. ART stops you from getting infections.
HIV treatment also helps you keep your appetite. And it helps your body absorb more of the nutrients from the foods you eat.
Your lifestyle also affects your weight. A high-calorie, high-fat diet and too little exercise could cause you to gain more weight while you’re on treatment.
Stress And Thyroid Hormones
Ashwagandha’s purported ability to help your body resist stress may help to balance your cortisol levels and boost low thyroid function that is the result of chronic stress, according to “”Prescription for Drug Alternatives,” by James Balch, et al. These purported effects, which Balch notes are backed by animal studies but not human trials, are likely to help stem weight gain rather than induce it.
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Why Might Weight Gain Increase With Art
Prior to the widespread release of ART in high-income countries in 1996, some people with HIV experienced inadvertent weight loss that in some cases could become severe. This was commonly called the wasting syndrome. When analyses were done, researchers found that affected people tended to lose muscle mass.
The causes of weight loss in untreated HIV infection are complex and may be related to intestinal inflammation and injury from infections, altered metabolism, decreased levels of hormones such as testosterone, and loss of appetite.
Once ART became available in 1996, researchers reported increased weight in patients, particularly those who had been suffering from the wasting syndrome, though this increased weight was mostly due to fat rather than muscle. Given the improved health that accompanies the use of ART, it is natural to expect some degree of weight gain over time.
People Living With Hiv/aids Have Increased Nutrient Needs
When infected with the HIV virus the body’s defence system – the immune system – works harder to fight infection. This increases energy and nutrient requirements. Further infection and fever also increase the body’s demand for food. Once people are infected with HIV they have to eat more to meet these extra energy and nutrient needs. Such needs will increase even further as the HIV/AIDS symptoms develop.
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Path To Improved Health
A few simple steps can help you make sure your food is healthy and safe:
- Wash your hands with soap and water before you eat so you wont get an infection from germs on your hands.
- Wash fruits and vegetables before you eat them or cook them.
- Wash your hands with soap and water after you touch raw fish, chicken, or meat to help prevent infection.
- Be sure that meat, eggs, and fish are well cooked before you eat them.
Here are some ways to add nutrition to your diet:
- Have high-calorie protein drinks or shakes. Adding powdered milk can increase the nutrition in other drinks.
- Drink 8 to 10 glasses of filtered water each day.
- Keep nutritious snacks on hand, such as nuts and carrot sticks.
- Eat high-calorie foods if youre losing weight.
- Talk to your doctor about taking a multivitamin every day. Take your multivitamin with a meal to help prevent an upset stomach.
How can I increase my strength?
Aerobic exercise such as walking will make you stronger. And it improves your mental health. Its good to begin exercising slowly. Little by little, increase the amount of time that you walk. For example, you might start walking for 20 minutes 3 times a week. Then, after you get a little stronger, you can increase the walking time to 30 minutes 4 times a week. Talk with your doctor before you start.
Dumbbell bench press
Remember: You can use cans of soup instead of dumbbells in these exercises.
Newer Type Of Hiv Drug Linked To Weight Gain
People on integrase inhibitors and protease inhibitors found to gain more weight on average than those on other treatment regimens
A study from the United States and Canada finds that people starting integrase inhibtor – and protease inhibitor -based antiretroviral treatment are more likely to experience weight gain than those on nonnucleoside reversetranscriptase inhibitor -based treatment.
Gaining weight after starting ART is common, particularly among people with lower CD4 cell counts and/or a lower body mass index . Weight gain as a result of HIV treatment used to be seen as a return to health. Yet in recent years, the average BMI of people starting ART has increased considerably, in line with increased BMI in the general population. This surfaces concerns around the negative effect such weight gain could have on peoples health.
The study set out to analyse changes in weight over time among people living with HIV, and examine whether different types of antiretroviral drugs are associated with greater weight gain. Due to having fewer side effects and drug resistance, newer INSTI-based drugs such as raltegravir, elvitegravir and dolutegravir are now the recommended treatment for most people living with HIV.
Around 22,900 adults, 87% of whom were men, who began ART through the North American AIDS Cohort Collaboration on Research and Design programme on or after January 2007 were followed until the end of 2016.
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Antiretrovirals And Weight Gain
“The trend towards greater weight gain with newer regimens may be a consequence of better gastrointestinal tolerability and less nausea.”
All antiretroviral drug classes were associated with weight gain but people receiving an integrase inhibitor gained significantly more weight than people taking either an NNRTI or a protease inhibitor .
Bictegravir and dolutegravir were associated with greater weight gain than elvitegravir, and rilpivirine was associated with greater weight gain than efavirenz. People who received bictegravir or dolutegravir had higher odds of a weight gain of more than 10% from baseline . Elvitegravir/cobicistat was also associated with higher odds of more than 10% weight gain compared to efavirenz.
Tenofovir alafenamide was associated with greater weight gain than tenofovir disoproxil and abacavir was associated with greater weight gain than TDF . TAF was the only nucleoside reverse transcriptase inhibitor associated with higher odds of > 10% weight gain, when compared to zidovudine , abacavir or TDF.
Basic Steps Towards Weight Loss
If you are overweight or obese there are some basic steps that you can follow to lose weight. These steps are the same for everyone, regardless of age or HIV status.
A risky combination of drugs, when drug A interferes with the functioning of drug B. Blood levels of the drug may be lowered or raised, potentially interfering with effectiveness or making side-effects worse. Also known as a drug-drug interaction.
To get started, it will help you to know how much you are eating and how physically active you are in an average week. Keep a food and activity diary for a week.
You can download apps that can help track activity. Most smart phones come with activity monitors pre-loaded. Alternatively, you can wear an inexpensive pedometer to record how far you walk each day.
Get a weight loss plan. You can download a 12-week weight loss guide from the NHS website. The plan is designed to help you lose weight at a safe rate of 0.5kg to 1kg each week by sticking to a daily calorie allowance.
Limit your calorie intake. For most taller people, this means sticking to a calorie limit of no more than 1900kcal a day, and 1400kcal for most shorter people. As we are all different, ideally see your HIV dietitian to have your own target calculated. A very low calorie diet should only be attempted after consultation with an HIV dietitian.Remember that some antiretroviral drugs need to be taken with food. Check which drugs need to be taken with food here.
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