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Study explores weight gain with HIV treatment

Kaiser Permanente researchers find weight gain associated with all types of antiretroviral therapy

A unique study comparing people with HIV starting antiretroviral medication treatment (ART) with demographically similar people without HIV found greater weight gain over 2 years in those with HIV.

Jennifer Lam, PhD

The analysis of Kaiser Permanente Northern California patients was published in Open Forum Infectious Diseases.

“This study confirms what clinicians have reported and what we’ve observed in other studies of people with HIV on ART,” said lead author Jennifer Lam, PhD, a research scientist with the Kaiser Permanente Division of Research. “We examine the issue of weight gain more rigorously by using a large health care dataset, which allowed us to include a comparison population of people without HIV and account for health conditions associated with weight change, such as diabetes and cardiovascular disease.”

The study included 8,256 people with HIV and 129,966 people without HIV who were patients in 3 Kaiser Permanente regions between 2005 and 2016. They were matched by sex, age, and race or ethnicity. The researchers followed change in BMI in the first 2 years after HIV patients started ART.

The study found the average annual change in BMI increased .53 kilogram per square meter (kg/m2) for people with HIV and .12 kg/m2 for people without HIV. The BMI increases were largely similar, though varied slightly, by ART medication class; .69 for integrase inhibitors and protease inhibitors, and .40 for non-nucleoside reverse transcriptase inhibitors.

It is common for people with HIV to gain weight early in their treatment, though that gain typically plateaus. In this study, BMI stabilized for most patients after the initial 2-year period.

The people with HIV tended to start out at a lower BMI than the comparison group without HIV, and saw their weights rise to a similar level as the comparison group, on average.

Michael Silverberg, PhD

“These results emphasize the importance of doctors monitoring HIV patients’ weight, particularly early in their treatment, and their cardiometabolic health,” said senior author Michael Silverberg, PhD, a DOR research scientist.

“As a frontline HIV practitioner, studies like this are extremely important,” said co-author William Towner, MD, a physician with Southern California Permanente Medical Group. “Knowing our patients living with HIV are at risk of excessive weight gain in their first several years of therapy allows providers to strengthen a message of preventative lifestyle modifications.”

The study was funded by Gilead Sciences, Inc.

Additional co-authors were Wendy A. Leyden, MPH, Stacey Alexeeff, PhD, Alexandra Lea, MPH, and Lakecia Pitts of the Division of Research; Rulin C. Hechter, MD, PhD, Qing Yuan of the Kaiser Permanente Southern California Department of Research and Evaluation; Haihong Hu, MPH, and Michael A. Horberg, MD, MAS, of the Mid-Atlantic Permanente Research Institute; and Julia L. Marcus, PhD, MPH, of the Harvard Medical School Department of Population Medicine.

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About the Kaiser Permanente Division of Research

The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 600-plus staff is working on more than 450 epidemiological and health services research projects. For more information, visit or follow us @KPDOR.

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