Predictors of Weight Gain, Metabolic Complications in Patients With HIV on Antiretroviral Therapy

Researchers evaluated factors associated with weight gain among patients with HIV infection receiving antiretroviral therapy.

Veterans with HIV infection were found to have lower rates of obesity overall compared with age-matched HIV-negative individuals. For patients with HIV infection, significant increases in weight were primarily observed within the first 2 years of antiretroviral therapy (ART) initiation and among those with lower BMI at diagnosis. These study findings were published in HIV Medicine.

Researchers at the Michael E DeBakey Veterans Affairs (VA) Medical Center in the United States sourced data for this study from the VA corporate data warehouse. Between 2000 and 2015, patients with HIV infection (n=22,421) were matched by age against those without HIV infection (controls; n=63,072) and evaluated to identify factors associated with changes in body weight. The researchers assessed patients’ body weight at baseline in comparison with years 1, 2, and 5 following HIV diagnosis (baseline visit for control patients), respectively.

Among patients in HIV and control groups, 96.7% and 96.3% were men (P <.01), 54.7% and 46.8% were younger than 50 years (P <.01), 51.1% and 18.1% were Black (P <.01), 47.2% and 19.6% had a baseline BMI of less than 25 kg/m2 (P <.01), 16.8% and 25.4% had diabetes (P <.01), and 61.9% and 69.8% had hypertension (P <.01), respectively. After 5-years of follow up, the study groups comprised 14,156 HIV-positive and 36,993 HIV-negative patients.

Researchers evaluated ART regimens among patients in the HIV group between baseline and year 1. Results showed that 55.2% of patients used nucleoside reverse transcriptase inhibitors (NRTIs) plus non-NRTIs (NNRTIs), 37.3% used NRTIs plus protease inhibitors (PIs), 6.40% used NRTIs plus integrase strand transfer inhibitors (INSTIs), and 1.07% used NRTIs plus other agents. After 5 years, the rate of patients receiving NRTIs plus NNRTIs (57.1%) or NRTIs plus PIs (40.5%) increased, and the rate of patients receiving NRTIs plus INSTIs (1.6%) or NRTIs plus other agents (0.86%) decreased.

Continue Reading

Between baseline and years 1, 2, and 5, significantly more weight loss was observed among patients in the HIV group who were not receiving ART vs those in the control group (all P <.01). Further analysis of this time period showed that significantly more weight loss occurred among patients aged between 50 and 59 years vs those younger than 50 years (all P <.01), with similar results observed among those 60 years and older vs those younger than 50 years (all P <.01). Significant increases in weight were observed among patients in the HIV group receiving ART vs those in the control group (P <.01 for years 1 and 2; P =.03 for year 5), as well as among those of Black vs White ethnicity (P <.01 for years 1 and 5; P =.05 for year 2).

Among patients in the HIV group receiving ART, predictors for weight loss at all 3 time points included being aged 50 years and older (all P <.01), a BMI between 25 and 29 vs 30 kg/m2 or higher (all P <.01), a BMI of 30 or higher vs lower than 25 kg/m2 (all P <.01), and a CD4+ count higher than 200 vs 200 or lower cells/mm2 (all P <.01). Predictors for weight gain at all 3 time points included receipt of NRTIs plus INSTIs vs NRTIs plus NNRTIs (all P <.01), HIV virologic suppression of more than 80% (all P <.01), and Black vs White ethnicity (P <.01 for years 1 and 2; P =.02 for year 5).

The most significant predictor for weight loss was a CD4+ count of more than 200 cells/mm2, which contributed to an estimated weight loss of -5.62 kg at year 1 (P <.01), -3.11 kg at year 2 (P <.01), and -0.95 kg at year 5 (P <.01).

Limitations include the retrospective design, the inability to adjust for changes in patients’ ART regimens, and the inability to match patients by race.

According to the researchers, “the findings from this study also demonstrate an interplay between an individual’s predisposition to obesity, viral factors, ART, and the environment.”


Garcia JM, Dong Y, Richardson P, et al. Effect of HIV and antiretroviral therapy use on body weight changes in a cohort of US veterans living with and without HIV. HIV Med. Published online August 5, 2022. doi:10.1111/hiv.13366