Hiv Treatment Considerations: Art And Patient Weight
Grace McComsey, MD, FIDSA: Tavell, in your clinic, how much does weight gain concern you? Do antiretroviral therapies play a role? When you see a patient and you want to choose a regimen for them, is that a big factor?
Tavell Kindall, PhD, DNP, APRN, FNP: It can be, particularly if someone is presenting with weight issues upfront. However, thats not the case. Where Im working, many times when come in, theyre newly diagnosed, sometimes they have advanced disease, and theyll experience a return to healthy weight with viral suppression and CD4 reconstitution. Once they gain the weight, their self-esteem is improved because people arent asking questions about why theyre losing all this weight. Now they look healthier, and as a result of that, they feel better and their self-esteem is better.
Grace McComsey, MD, FIDSA: Osama, initially in HIV , is it true what Tavell said? They wanted to gain weight, right? We had a problem with wasting, so we thought weight gain was good. It was a return to health. Now we know that, for some individuals, its getting out of control. Theyre gaining too much weight. Do you want to comment on weight gain and the relationship to other metabolic complications? Is it good to have a lot of weight? Some people see it as a good thing, right?
Transcript Edited for Clarity
How To Talk To Your Doctor About Weight Gain And Hiv
Many people diagnosed with human immunodeficiency virus experience weight gain after starting antiretroviral therapy . In a survey of 129 myHIVteam members, 75 percent reported having gained weight since their diagnosis.
About 78 percent of myHIVteam members surveyed said they believe maintaining a healthy weight is important. Because an ART regimen is a vital part of living with HIV, its important to find ways to stay on those medications and maintain a healthy weight.
If you are struggling with weight gain after starting treatment for HIV, the best thing you can do is talk to a doctor and come up with a plan. After all, 82 percent of myHIVteam members surveyed said it was helpful to receive professional guidance about maintaining their weight.
Gaps In Risk Communication
WLHIV participants widely emphasised the importance of knowledge about side effects to reduce their anxieties and enhance adherence and timely reporting of side effects. Most said they were not informed about the full range of DTG side effects, especially those related to pregnancy, weight gain and diabetes. The lack of adequate information festered misconceptions, which may have undermined or promoted DTG uptake, including beliefs that DTG is going to cure us completely and DTG acts as family planning .
Information about possible side effects was provided in leaflets that were written in English and/or Luganda, often without an accompanying explanation from health workers. There is no information I was given. I was just called from the pharmacy and told, “you have been switched to this new drug, in case of any side-effect call us on this number . Several women reported that they could not read the leaflet. They gave me just a paper, but I cant read . Those who could read said they found leaflets useful as they provided a reference to check against symptoms:
it was useful to me because it had those signs and symptoms. If it was not given to me, I would wonder ‘what was happening to me’? But when they gave it to me, I read it and know that “eh, this is the side-effect of the drug” and I stay strong . I continue swallowing my drugs knowing that it will stop. .
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Increase Your Intake Of Vitamins And Minerals
Your immune system needs vitamins and minerals to function properly. When you are ill with HIV/AIDS you need even more.
- Eat a variety of vegetables and fruit every day, as these are a valuable source of vitamins and minerals.
- Take care not to lose vitamins and minerals when cooking your food. Boil, steam and fry vegetables only for a short time.
- Multivitamin and mineral supplements, usually in the form of pills, can help but they are expensive and leave less money for food.
- Too many vitamins and minerals can harm you. If you take supplements, follow the instructions on the label.
- It is very important to try to eat, even though you may not feel like eating, to avoid weight loss.
- Treat infection as early as possible. If you are ill for more than a couple of days see a health worker.
Managing Weight Gain With Hiv
Many myHIVteam members experience frustration with trying to maintain a healthy body weight. As one member posted, Im really having a weight loss struggle. My doctor told me I need to lose 40 pounds and start watching my diet better because my cholesterol is through the roof. Ive lost 10 pounds, but I’m stuck and not losing any more. Does anyone find that their medicines cause weight gain or keep them from losing weight?
While trying to lose weight with HIV can be frustrating, there are some steps you and your health care team can take to help you reach the right weight for you.
Make Some Changes To Your Diet
A healthy diet is extra important when you have HIV. You need good nutrition to keep up your energy and strength and help your immune system work its best. Your doctor and a dietitian can give you advice on how to reach your weight and nutrition goals with diet.
Eating more protein and calories can help you gain weight. Extra protein also helps to strengthen your immune system. Nuts, cheese, eggs, and lean meat are all good sources of protein.
Increase your daily calorie count by adding foods high in healthy fats and carbohydrates, like peanut butter, avocado, pasta, and potatoes. Ask your doctor if you should also take a multivitamin.
If you don’t have much of an appetite, eat smaller meals and snacks six to eight times a day. Small portions may be easier for you to eat than big meals. If you have mouth sores, eat bland foods that won’t cause pain. Avoid spicy foods and citrus if they hurt your mouth.
If you need to lose extra weight, cut back on fat and calories. Your doctor can give you a daily calorie goal for your body type and height. Eating more nutrient-dense and calorie-light foods like fruits, vegetables, and whole grains is one way to reach your target weight.
Can You Prevent Weight Loss If You Have Hiv
Lifestyle and self-care measures can help with maintaining weight. These include:
- eating a healthy diet with a good balance of calories and nutrients, such as protein for building and keeping muscle mass
- working out routinely to strengthen and boost muscle mass
- seeking help from a licensed therapist for mental health support
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Managing Your Weight During Hiv Treatment
You may have noticed that your pants got tighter, or looser, after your HIV diagnosis. Weight gain and loss are both common with HIV, and they happen for different reasons.
It’s important to stay healthy when you have HIV, and that includes keeping your weight in a healthy range. There are things you can do to lose any extra weight you’ve gained or gain back what youâve lost.
Start by talking to your doctor. Together you can figure out the cause of your weight changes and find solutions.
The Bottom Line On Hiv Antiretrovirals And Weight Gain In 2021
At least two formerly common HIV drugs suppress weight: TDF and probably efavirenz. Therefore, the initiation of weight-neutral regimens will appear to be associated with weight gain in comparison to those containing either TDF or efavirenz. For example, in the ADVANCE trial, weight gain was highest for those assigned to start the combination of FTC/TAF plus dolutegravir, followed by those taking FTC/TDF plus dolutegravir by comparison, people on efavirenz/FTC/TDF had minimal weight gain. Our first impression was that the integrase inhibitor, possibly abetted by TAF, was responsible for the weight increase. However, it is also possible that TDFand perhaps efavirenzsuppressed weight.
Similarly, a switch off of TDF is almost assured to lead to weight gain, regardless of what the new regimen consists of. This makes assessments of the differential effects of antiretrovirals on weight tricky.
This is reminiscent of the TDF lipid story from several years ago: The drug suppressed lipid fractions, so when TDF was discontinued in favor of TAF, these levels roseleading some to label TAF as lipid-unfriendly. Here, too, differences in weight change could be due to drug-mediated suppression, drug-mediated gain, or a combination.
There is much we still have to understand about weight changes and HIV therapy, but one thing is for sure: it is not simple.
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Write Down Your Concerns
Before meeting with your doctor, write down any specific concerns youd like to address. Having a list can help you feel prepared for your appointment. You may note that you have gained a certain number of pounds over a certain period of time, or that you have developed new medical symptoms since gaining weight.
Additionally, write down any of the ways your mental health or self-esteem have been impacted by weight gain. Your doctor may help you address these concerns or refer you to a mental health specialist, such as a psychiatrist or therapist.
If youre concerned about weight gain and your HIV treatment, its important to ask your doctor directly, since this potential side effect may not be top of mind for them. Only 42 percent of surveyed myHIVteam members were told by doctors that HIV medication could cause weight gain.
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.
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Weight Gain While Treating Hiv: Why It Happens
Weight loss used to be a big problem for people with HIV. The virus lessens your appetite. It also causes infections that your body has to burn extra calories to fight. Before good treatments were available, some people with HIV got wasting syndrome, where they lost more than 10% of their body weight and got very weak.
Today’s antiretroviral therapy prevents weight loss and helps you live a longer, healthier life with HIV. But these drugs can cause the opposite problem with weight. They could make you gain weight –sometimes too much.
How Does Hiv Affect Weight
HIV can affect your appetite or cause symptoms like mouth sores and nausea that make it harder for you to eat. You also burn more calories with HIV because your body needs extra energy to fight infections.
Weight loss used to be a big problem for people with HIV. Sometimes people lost so much that their doctors called it “wasting.”
Today, HIV treatments prevent extreme weight loss. Antiretroviral treatment keeps the virus under control and stops you from getting infections. Once you’re on treatment, you might actually gain weight, especially in your belly. That’s because weight gain is a side effect of some HIV drugs, like the integrase inhibitors and tenofovir alafenamide.
About 1 out of 6 people gain at least 10% of their body weight within 2 years after they start ART. If you eat a lot of foods that are high in calories and fat and donât get enough exercise, you can add more pounds on top of that.
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When Should You Watch For Weight Gain
After you start ART, your odds of weight gain are highest within the first 12 to 18 months, Koethe says. In that period of time, studies show about 37% of people will gain 5% of their body weight. Another 17% will add 10% of their body weight.
Your weight might keep going up for several years after the start of ART, Koethe says, âbut at a much slower pace.â
Wlhiv Aversion To Thinness
The majority of WLHIV participants described their current body size as slim, attributing it to the distress of their diagnosis and previous ART-related side effects and wanted to regain their normal weight. WLHIV appeared to have a strong aversion towards the thin body figure, mainly because it was commonly associated with serious ill-health and could lead to people suspecting their HIV sero-positive status. Thin people were reported to be widely stereotyped and stigmatised as HIV patients, as noted by these women:
Some people are so slim to the extent that everyone says, “HIV is finishing that one” “see how the clothes are not fitting her”. They point fingers at us, they despise us. We should have bodies that are not slim.
Thinness was associated with low self-esteem and a lack of confidence in body appearance which constrained social participation, as noted by this middle-aged WLHIV: I want a body that does not embarrass me, that does not scare people, that looks good, one which is not too slim. WLHIV participants who experienced weight loss after DTG were displeased and noted it affected confidence and social participation.
That drug caused me problems because those that know me when they see me now, they talk a lot. Some say, maybe she got HIV, or I got an abortion, or she is using suspicious drugs. … Im even scared of going to the village.
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Why Do People With Hiv/aids Not Eat Enough Food
- Illness and medicines reduce appetite, modify the taste of food and prevent the body from absorbing it.
- Symptoms such as a sore mouth, nausea and vomiting make it difficult to eat.
- Tiredness, isolation and depression reduce the appetite and the willingness to make an effort to prepare food and eat regularly.
- There is not enough money to buy food.
Gain weight by eating more food
Get Support For A Healthy Weight With Hiv
At myHIVteam, the social network and online support group for people with HIV, members talk about a wide range of personal experiences and concerns. Weight gain with HIV is a commonly discussed topic.
Have you started treatment for HIV and struggled with weight gain? Have certain changes in your diet, exercise, or treatment regimens helped? Let other members know by leaving a comment below or starting a conversation on your Activities page.
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What Is Hiv Weight Loss
HIV weight loss, sometimes called HIV wasting syndrome, is an unplanned weight loss of more than 10 percent of body weight with either diarrhea or weakness and fever that lasts more than 30 days.
This type of weight loss often occurs with more advanced HIV. Lean body mass tends to be lost, but weight loss may be body fat as well.
The risk of death does increase with each 1 percent increase in weight loss from baseline weight in people living with HIV. Moreover, this risk rises by 11 percent with each 1 percent increase in weight loss from the prior visit.
HIV weight loss can result from a mix of factors such as:
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.
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Impact Of Weight Gain
Weight gain can have an effect on your emotional and physical well-being. In our survey of myHIVteam members, 60 percent said that gaining weight lowered their self-esteem.
Gaining weight can also impact a persons overall health. Weight gain among the general population has been associated with a wide variety of health problems, including high blood pressure, high cholesterol, and high triglycerides . A higher risk for cardiovascular disease, type 2 diabetes, stroke, and certain types of cancer are also associated with carrying excess body weight.
Concerns About Body Weight
WLHIV participants appeared to be less concerned about DTG-related weight gain, which they regarded as a common feature of HIV treatment. Many of those reporting weight gain said it was marginal, did not distract them from doing their normal work and believed it would not last long. Weight gain was interpreted by some HCWs and WLHIV as an outcome of the positive living, which PLHIV are encouraged to embrace. They would only become concerned if they became extremely fat and face difficulty walking , or it resulted in a debilitating disease. Excessively fat women were noted to be widely stereotyped as lazy and useless and unable to perform daily activities expected of a wife, affecting their marriage and marriage potential.
Several women said they received a lot of compliments from friends and felt good for gaining weight after switching to DTG. Young women often differentiated two types of weight gain: one, which is desired, entail uniform increase across all parts of the body and the other, which is disliked, involves excess fat at specific parts of the body such as abdomen, face, etc.,
I like to put on weight, but I do not want to get too fat to the extent of being shapeless. I want to gain bodyweight in a considerable way, one which is uniform. And not like one part of your body is big and other is small. .
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