A Patient’s Perspective: Managing Weight Gain on ART My Way

Key Takeaway

• I’m doing really well on my current ART regimen, with the exception of the weight gain that I’ve recently noticed. I’ve made the decision to remain on my current ART regimen and manage my weight with lifestyle changes for now.

I was first diagnosed with HIV in January 2001 as an acute infection. My HIV physician thought  I was probably infected within 2 weeks of presenting with multiple symptoms. I was very sick and my viral load was very high, more than 1 million copies. I immediately started a 4-drug regimen that was being used at the time. Within a short time that I remember being approximately 3-4 months (but was probably more), my viral load was undetectable and my CD4+ cell count was back to the normal range. I have remained undetectable since then.

After 4 different antiretroviral therapy (ART) regimens since my HIV diagnosis in 2001, I am finally on a regimen that has worked well for me in terms of managing my HIV infection and adverse events. The one adverse event that I am experiencing is weight gain.

My Weight, My Way
Taking my age and height into consideration, I should weigh about 175 lb, but I struggle to stay under 190 lb. My doctor thinks that this may be the result of my ART regimen. In the past 4 years, I was also diagnosed with nonalcoholic fatty liver disease, which hasn’t been directly attributed to my HIV medications, but my own research has shown me that HIV and some HIV medications can affect the liver and the kidneys. I do drink alcohol and that obviously exacerbates my liver disease and may have an impact on my weight as well.

Even if my ART could be a factor in my weight, I really feel as though I am well managed. I like the fact that my regimen is just 1 pill per day. I’m very, very disciplined about taking my medications. I’ve never missed or skipped doses. So as long as I’m healthy and not having symptoms, I plan to continue on my current regimen unless there’s a new regimen proven to have less impact on my weight, liver, and kidneys. I plan to manage my weight with lifestyle changes.

Future Plans for My HIV Regimen
As of yet, there has not been discussion with my HIV physician about changing my HIV regimen because of weight considerations. I manage my weight through exercise and diet and have also worked to reduce my alcohol intake. I recently retired and have set, as part of my retirement goal, that I will exercise twice per day. I do so by taking my dog on 2 walks per day.

I know there are other ART options out there, but for me and my doctor, there aren’t enough data yet to suggest that switching would significantly affect my weight. One intriguing option to me is a long-acting injectable regimen, but—for it to be worth the switch for me—I would prefer something I could inject on my own and I would need to see convincing data on whether any new regimen would positively affect my weight and be less harmful to my liver and kidneys. At this point, my doctor and I have made the decision to continue my current oral regimen.

Your Thoughts?
Do you have patients struggling with weight gain but otherwise doing well on their current regimens? What are you recommending? Leave a comment and join the conversation.