II. Pathophysiology
- Effective ART increases weight by improving health and reversing HIV-related catabolism
- Specific Antiretroviral therapy (ART) agents may also increase weight
- Integrase Strand Transfer Inhibitors (Dolutegravir, Bictegravir)
- Nucleoside Reverse Transcriptase Inhibitor (nRTI, e.g. Tenofovir Alafenamide)
- Protease Inhibitors are associated with fat redistribution (Lipodystrophy)
III. Management
- See Obesity Management
- See Insulin Resistance in HIV
- See Hyperlipidemia Management in HIV
- Lifestyle changes (e.g. weight loss, Healthy Diet, Exercise)
- Consider GLP1 Agonists (e.g. Semaglutide, Tirzepatide)
- Avoid switching ART agents strictly for reasons of weight gain with a few exceptions
- Consider Protease Inhibitor change in Lipodystrophy
- Consider switching to Tenofovir disoproxil Fumarate (TDF) from Tenofovir Alafenamide (TAF)