Which Drugs Have Been Linked To Weight Gain
Greater weight gain is seen in people who start treatment with a combination that contains the integrase inhibitors dolutegravir, bictegravir or elvitegravir, or the NRTI tenofovir alafenamide . People taking raltegravir were more likely to gain weight when compared to people taking a boosted protease inhibitor . The greatest weight gain has been seen in people taking dolutegravir with TAF . Weight gain has been greater in people taking antiretroviral drugs introduced in the past ten years .
Who Is More Likely To Gain Weight On Art
Koethe and his colleagues found that 3 years after the start of ART, about 22% of healthy-weight people became overweight. Among those who were already overweight, he says about one-fifth became obese. But those numbers dont help experts predict much.
Theres ongoing research into how much of a role your genes play. Koethe says theres emerging data that certain drug-metabolizing enzymes might affect weight gain. In the future, that might shine a light on whos more likely put on extra pounds after the start of ART.
Can You Gain Weight With Hiv
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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:
- Rilpivirine
- Zidovudine
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:
- Cabotegravir
- Dolutegravir
- Raltegravir
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.
The Impact Of Weight Gain On Diabetes Risk In Cart
Glucose disorders are prevalent in treated HIV-infection . Studies that have reported the association between incident glucose disorders and weight gain in treated HIV-infection are summarised in Table 1. A recent meta-analysis of 44 studies of cART-recipients published between 2000 and 2017 showed pooled incidence rates for pre-diabetes and diabetes of 125/1000 and 13.7/1000 person-years of follow-up , respectively. Substantial incidence heterogeneity was evident between studies, likely due to differences in participant demographics, cART regimens and duration, and diagnostic criteria for diabetes. However, many of these studies likely underestimated diabetes incidence, for various reasons. For example, HbA1c may underestimate glycaemia in treated HIV-infection due to cART effects on erythrocyte dynamics and haemolysis, which reduce the erythrocyte life span, thereby lowering HbA1c . A second factor is the lack of generalised use of the diagnostic 75 g OGTT which will often detect diabetes missed by fasting glucose and/or HbA1c measurements in cART-recipients. A recent study found that the 75 g OGTT identified an extra case burden of 54% of pre-diabetes and 11% of diabetes cases missed by fasting plasma glucose measurements . A further study has confirmed the utility of the OGTT which diagnosed 5.9% of diabetes cases in 220 cART-recipients, compared to 3.2% using fasting glucose and no cases with HbA1c .
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Why Is Weight Gain A Problem
If you were underweight when you started treatment, putting on a few pounds isn’t a bad thing. Getting to a healthy weight gives your body strength to fight HIV and other infections. Doctors used to call this weight gain a “return to health.”
But now the scales have tipped in the other direction. People with HIV in the United States are more likely to be overweight than those who dont have the virus. Putting on too many pounds can lead to health problems like diabetes and heart disease. If you have HIV, youre already at higher risk for these conditions.
Weight gain is an important thing to consider when you and your doctor choose an HIV drug, especially if you were overweight to start. You may be able to switch to a medicine that’s less likely to cause weight gain. Diet and exercise can help you stay at a healthy weight and avoid complications that are linked to being overweight.
The Role Of A Dietitian
If a person has difficulty eating, they should consult a registered dietitian. They can ask a doctor for a referral to one who has experience with people living with HIV or AIDS.
Not everyone with HIV has impaired immunity. People with the condition also do not always experience the same symptoms of the infection or the same side effects of medication. Also, some individuals with HIV may have other conditions that a balanced diet can help with.
A dietitian can tailor a diet to meet a personâs specific nutritional needs.
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Special Eating Needs For People Living With Hiv/aids
A person who is infected with HIV/AIDS and is not showing signs of illness does not need a specific HIV-diet. However, those infected with HIV should make every effort to adopt healthy and balanced nutrition patterns in order to meet their increased protein and energy requirements and maintain their nutritional status.
Once people with HIV/AIDS become ill they will have special needs, which are described below.
Distinguishing Return To Health Weight Gain From An Obesity Trajectory
Figure 1. The intersection of the modern obesity epidemic and historical changes in HIV-infection prescription and timing and their contribution to weight gain and redistribution during HIV treatment.
Therefore, substantial evidence supports a phenomenon of return to health weight gain observed following cART-initiation. A limitation of all these studies is the lack of true baseline healthy weight measures, recognising that such measures were unfeasible or would need to rely on self-reported data. This reset of body habitus equilibrium following effective treatment of a catabolic infection requires distinguishing from excessive weight gain and specific body fat partitioning disorders, such as lipodystrophy.
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Metabolic Impact Of Weight Gain
Some researchers have suggested that substantial weight gain after starting antiretroviral treatment could lead to a higher risk of cardiovascular disease or diabetes. For this analysis, researchers looked for an association between > 10% weight gain and the onset of diabetes or hyperglycaemia but found no association. People who gained greater than 10% of body weight had slightly higher total cholesterol to HDL cholesterol ratios after 96 weeks but the difference is unlikely to be clinically meaningful.
How Do I Keep From Losing Weight
Diet and Nutrition
Weight loss can be a common problem for people with relatively advanced stages of HIV infection, and it should be taken very seriously. It usually improves with effective antiretroviral therapy . Losing weight can be dangerous because it makes it harder for your body to fight infections and to get well after you’re sick.
People with advanced HIV often do not eat enough because:
- HIV may reduce your appetite, make food taste bad, and prevent the body from absorbing food in the right way. Some HIV medicines may also cause these symptoms .
- symptoms like a sore mouth, nausea, and vomiting make it difficult to eat
- fatigue from HIV or medicines may make it hard to prepare food and eat regularly
To keep your weight up, you will need to take in more protein and calories. What follows are ways to do that.
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What Are The Long
Weight gain soon after starting treatment in people who were previously underweight reduces the risk of death. This is an example of the return to health effect.
However, in the long term, weight gain in people with normal body weight prior to treatment may increase the risk of cardiovascular disease and diabetes .
People living with HIV are at increased risk of cardiovascular disease compared to the general population. This increased risk is especially pronounced in women and younger people.
Abdominal fat gain on antiretroviral treatment raises the risk of diabetes, as does overall weight gain . A large study of over 49,000 people followed for five years after starting treatment found that those with normal body weight at the time they started treatment had a greater risk of cardiovascular disease the more weight they gained after starting treatment . Underweight people did not have a similarly increased risk.
Basic information on a healthy weight
The ADVANCE study found that weight gain was associated with a small projected increase in the risk of developing type 2-diabetes over ten years, but the overall risk remained low . The same study did not find an increased risk of cardiovascular disease as a result of weight gain.
Obesity and diabetes are risk factors for the development of neurocognitive impairment in people living with HIV.
How Worried Should I Be
If you’re worried about weight loss, talk to your doctor.
INSTIs are most likely to cause weight gain, and they’re often the first medications doctors prescribe. HIV medicine is important to help you stay healthy. But if you started out overweight, you may be able to switch to a drug that’s less likely to make you gain a lot of extra weight.
Nutrition and exercise are also important for managing your weight and keeping you healthy overall. A well-balanced diet gives your body the energy it needs to fight HIV and other infections. Your doctor and a dietitian can help you find the right eating plan for you.
You also need exercise to prevent weight gain and keep your muscles strong. Having HIV shouldn’t stop you from taking part in whatever exercise program you like, whether it’s walking, biking, dancing, or playing sports.
WebMD Medical Reference
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Weight Gain Cart And The Modern Obesity Trajectory: The Obesogenic Environment
In reviewing the potential effects of cART initiation on weight, it is important to consider the impact of existing in the modern obesogenic environment. People living with treated HIV-infection today enjoy greater life expectancy and thus are more exposed to the obesogenic environment and accumulate age-related cardiometabolic risk factors . For example, the metabolic syndrome occurs in 1724% of people living with treated HIV and its prevalence increases with age .
Relatively recent data show that people living with HIV-infection have rates of overweight and obesity similar to that observed in the uninfected population . US data from 2000 onwards show high rates of overweight and obesity between 40 and 63% in people living with HIV-infection both pre-cART and on cART , with no sparing of youth and paralleling US obesity statistics in the general population . In contrast to earlier studies on cART initiation in the late Twentieth century where body habitus at HIV diagnosis was characterised by cachexia, recent US data show that 4454% of people initiating cART are either overweight or obese, prompting authors to raise the question, where did all the wasting go? .
Is It Ever Ok To Lose Weight When Living With Hiv
Wider introduction and use of ART has been linked to increased weight gain and cases of overweight and obesity in people living with HIV.
Those with overweight and obesity may have a higher body mass index and a higher ratio of BMI to visceral fat, a type of body fat stored in the abdominal cavity. It wraps around vital organs such as the pancreas and liver.
Compared to the general population, having this ratio combined with HIV may raise the risk for health issues such as heart disease, type 2 diabetes, and certain cancers.
For instance, data from 2016 found that for every 5 pounds someone with HIV gains, the risk for diabetes goes up by 14 percent, compared to 8 percent in the general population.
For those with overweight or obesity and HIV, losing weight may improve overall health and lessen the risk of some health issues.
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In Thebodypro’s Top 10 Hiv Clinical Developments Of 2020
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As 2020 draws to a close, we asked David Alain Wohl, M.D., a professor of medicine in the Division of Infectious Diseases at the University of North Carolina and a highly respected HIV clinician-researcher, to take stock of the year’s most momentous research developments and other critical events. In this exclusive series of articles, Wohl calls attention to 10 such developments that have tremendous short-term implications for our day-to-day efforts to improve HIV prevention, treatment, patient care, and policy in the U.S., and analyzes each development with his trademark wit and clinical savvy.
A top story in HIV medicine in 2019 was the excess weight gain experienced by some during HIV treatment with integrase inhibitors. These antiretrovirals had quickly become the special sauce of HIV therapy: They were potent, had a high resistance barrier, and were very well-tolerated.
Make that: Mostly very well-tolerated.
This year solidified much of what we first heard last year. Additional follow-up from the ADVANCE trial, a study of initial antiretroviral regimens conducted in South Africa, laid out the differential effects of HIV therapies on weight. It showed continued accumulation of kilograms for those randomized to dolutegravir , especially when combined with tenofovir alafenamide /emtricitabine , a.k.a. Descovy.
A Sexually Transmitted Infection
Katie Salerno/Flickr Creative Commons
Contracting other sexually transmitted diseases can significantly increase the risk of getting HIV. For instance, some STDs like syphilis and herpes cause skin lesions that make it easier for HIV to enter the body.
STDs may also cause inflammation, which is something that is triggered by the body’s immune system. HIV preferentially infects defensive white blood cells, so when there are more of them around, it’s easier to contract HIV.
Having an STD like gonorrhea or syphilis means that you’ve engaged in unprotected sex, a key risk factor for HIV. So if you have been diagnosed with an STD, talk to your healthcare provider about how you can reduce your HIV risk.
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Will Truvada Make Me Gain Or Lose Weight
While some might see a slight weight gain, it’s usually gone after a couple weeks.
Before getting prescribed Truvada as PrEP, an HIV prevention strategy that when taken as prescribed makes it virtually impossible to contract HIV, we always have a slew of questions. Most of them have to do with whether or not the drug will change or limit our lifestyles.
According to NationalEatingDisorders.org, queer folks are disproportionately impacted with eating disorders, many of which are manifested through heightened workout routines at the gym or an extensive amount of health and body concerns in our daily tasks.
For some, the rumor that Truvada creates weird fat gains or shifts without our consent prevents us from doing more research. But Im here to tell you… theres nothing to worry about.
As reported by NAM AIDSMap, an international HIV information resource, PrEP doesnt raise lipids or alter body fat. However, the study did show that Truvada is associated with a slightly lowered cholesterol level and suppression of body fat gain, though both are likely short-term.
Numerous studies have shown Truvada to be a safe and well-tolerated drug . According to Gilead, about one in 10 people in studies reported they had nausea, stomach pain, or weight loss when they first started taking PrEP. Most of the time, these side effects improved or went away after taking PrEP for a few weeks.
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.
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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.
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 .
diabetes
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 .
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