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Gewichtszunahme durch ART: Was Sie wissen sollten

von NFI Redaktion

After beginning antiretroviral therapy (ART), most people with HIV experience weight gain. This is generally considered a positive sign that the ART is working. Your doctor may refer to this initial weight gain as „health restoration.“ However, excessive treatment-related weight gain can potentially lead to future health issues.

„Three decades ago, during the early days of the HIV epidemic, we were concerned about malnutrition and wasting,“ says Onyema Ogbuagu, MBBCh, an infectious diseases specialist at Yale Medicine. „As we have made strides in diagnosing the disease earlier and have more effective treatment options, we are now dealing with a different type of metabolic issue, namely obesity.“

If you are concerned about treatment-related weight gain, inform your doctor. They will discuss the pros and cons of your ART and help you find safe ways to lose weight.

Here are some additional topics you may want to discuss with your healthcare team.

What are the Health Risks of Treatment-Related Weight Gain?

Ogbuagu states that older types of ART could cause lipodystrophy, altering the way your body stores fat and potentially leading to abdominal fat linked to insulin resistance, diabetes, and heart issues. However, such fat changes are much less likely with newer medications.

There is evidence suggesting that short-term treatment-related weight gain from modern ART can still increase the risk of certain metabolic problems. Further research is needed to fully understand all the long-term effects of treatment. ART-related weight gain could lead to:

  • Type 2 diabetes
  • High cholesterol (also known as hyperlipidemia)
  • Non-alcoholic fatty liver disease

„The data for diabetes and liver fat is definitely there,“ says John Koethe, an assistant professor in the Division of Infectious Diseases at Vanderbilt University. However, there are contradictory findings regarding cardiovascular disease. While obesity and overweight increase the risk of cardiovascular disease, it is still unclear whether ART-related weight gain further increases these odds. More research is needed to determine this.

„People with HIV already have a significantly increased risk of cardiovascular disease,“ says Koethe. „The concern could be that the risk attributed to weight gain has not yet emerged in studies.“

It is important to note that excessive body weight, regardless of the type of ART you are taking, can increase the risk of certain health problems, including:

  • Sleep apnea
  • Cognitive decline
  • High blood pressure
  • Heart disease and stroke

When Should You Be Concerned About Weight Gain?

Koethe suggests that the likelihood of weight gain is highest within the first 12 to 18 months after starting ART. Studies show that approximately 37% of people gain 5% of their body weight during this period, with another 17% gaining 10% of their body weight.

According to Koethe, your weight may continue to rise for several years after starting ART, but at a much slower pace.

Are All Treatment-Related Weight Gains Associated with Risks?

If you are underweight or of normal weight, a few extra pounds may be okay and even healthy. „Weight gain is not always a bad thing,“ says Ogbuagu. „It may be desirable for some people.“ He adds that it could even improve your well-being.

However, in general, doctors usually are concerned about future health problems if you gain 5% of your body weight after starting ART. People store this weight in different ways, but he says that the risk of certain medical issues increases when fat accumulates around the internal organs.

„In these individuals, there is a higher risk for fat accumulation around the liver, heart, and skeletal muscles, leading to a higher risk of metabolic diseases such as diabetes and other accompanying conditions,“ says Koethe.

It is difficult to detect where your fat is located just by looking at your body. However, there are tests that your doctor can perform to gain a more detailed insight. These tests may include:

  • Measure your waist circumference. Your risk for diabetes and heart disease is higher if your waist measures more than 35 inches for women or 40 inches for men.
  • DEXA- (or DXA-)Scan. This is a type of bone density test that can also show where your body stores fat and muscle.
  • CT-Scan. This advanced tool can provide your doctor with information about fat in and around your liver, skeletal muscles, heart, or other organs.

Who Is More Likely to Gain Weight on ART?

Koethe and his colleagues found that three years after starting ART, approximately 22% of people with healthy weight were overweight. He notes that from those who were already overweight, about one-fifth became obese. However, these figures do not provide much predictability for experts.

Research is ongoing into the role of genetics. According to Koethe, new data suggests that certain drug-metabolizing enzymes could influence weight gain. This may provide insight into who is more likely to gain additional pounds after starting ART in the future.

Should You Change Your ART?

Discuss your treatment with your doctor. They may consider switching you to another medication if you have gained a significant amount of weight. However, there are many factors to consider before making a change.

If you have not yet started treatment, current guidelines do not consider weight gain or metabolic issues before starting ART. Discuss this with your doctor if these are health concerns you or other family members have.

Currently, there is not enough scientific data to support a change in standard guidelines, according to Koethe. This is because integrase inhibitors, which are associated with weight gain, are much better at preventing drug resistance.

The best course of action, according to Koethe, is to begin or continue a healthy diet and exercise regimen, particularly at the start of ART. Additionally, keep your doctor informed about your weight gain. They may perform routine checks of vital health measures such as:

  • Blood sugar
  • Blood pressure
  • Cholesterol levels

Your doctor may not choose or change your ART solely based on concerns about obesity. However, Ogbuagu says that you should still discuss this with your doctor. „I believe we should take action early, in the first few months or first year, to prevent people from gaining further and developing new complications at the same time.“

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