The treatment of HIV (antiretroviral therapy) has changed the face of HIV/AIDS. Successful treatment now allows millions of infected individuals to keep the virus under control – even undetectable – and live a healthy life.
However, as with all medications, it can have side effects. For some people, weight gain is one of them. Current studies show that one in six people who start taking HIV medication gain at least 10% of body weight within a year or two. Why this happens is still a mystery. If you were underweight at the time of diagnosis, weight gain may be welcome and a milestone on the way to so-called „health restoration“. But if you are normal weight or overweight, it can be a persistent problem and lead to weight-related health issues, including diabetes and heart disease.
HIV affects black/African American gay, bisexual, and other men who have sex with men more than any other group in the United States. More than a quarter of the nearly 37,000 new infections in 2019 were in black/African American gay and bisexual men. Weight gain is more common among black individuals in treatment, so it may affect a larger number of black gay men. Reginald Austin and Eric (name changed to protect his privacy) are two black gay men struggling with weight gain due to HIV medications.
Eric, 48, was diagnosed three years ago. He started taking the HIV combination medication Biktarvy and noticed weight gain within 4 months. „My weight fluctuates naturally, but I’ve never experienced as much weight as I currently am. Initially, I attributed the difficulty in losing weight to my age and slower metabolism.“ Eric has gained a total of 35 pounds but lost 15 pounds. It was a struggle to maintain his weight. Eric has regained the same 15 pounds a few times. Eric says he has had some success by consuming plenty of fiber and replacing one meal a day with a protein and vegetable powder shake with small amounts of fresh fruit and ginger. Biktarvy has ensured that Eric’s viral load is undetectable. „Apart from my high blood pressure, I’m considered healthy. Without the weight gain, I would be even healthier.“
Reginald Austin’s Story: Austin was diagnosed at the age of 19. That was 15 years ago, and his viral load is now undetectable. During his journey, Austin gained weight after starting at least one year of therapy. His family jokingly gave him the nickname „Lurch“ (from The Addams Family) before his weight gain because he was so tall and thin. His weight increased from 174 pounds to 248 pounds. His father once made a remark and said, „God, my son, how big are you going to get?“ The medications store fat in the midsection, and „it just won’t go away,“ Austin says, and adds that it’s difficult to lose weight in that area. Austin says everyone he knows gains weight after starting medication. He works as a Linkage-to-Care Coordinator and Case Manager at Thrive SS, an organization in Atlanta that aims to support health equity for black gay men and advocate for it.
He works with newly diagnosed people, who are usually very ill, thin, frail, and dissatisfied with their appearance. „I look at them, smile, and say, ‚Darling, trust me, if you take the medication, that will stop.'“ Austin says people are initially excited because they’re doing better with the medication. Yet, weight gain often doesn’t stop. Now, at 34, Austin takes the combination pill Dovato, which he calls „a breath of fresh air.“ He now weighs 197 pounds, but says it’s still difficult to control his weight. Austin says that he was at risk of developing other health problems due to his weight, so he changed his habits. He went back to the gym, and credits his plant-based diet for helping him lose weight.
Austin says he’s at a „happy point“ in his life, but not at „peace.“ He fears that his weight could „explode again“ if he changes medications. He says, „I’m nervous about switching to the (long-acting) injections. My first question is, ‚Will it cause weight gain?'“
Living a Healthy Life with HIV „It’s very important to have regular visits with healthcare providers, particularly infectious disease doctors, as they generally have a better understanding of living with HIV and the comorbidities that come with HIV,“ says Eric. „I would urge everyone to hope for research that will contribute to a longer, healthier life.“ Talk to your doctor if you’re concerned about your weight. Your doctors may be able to develop a new treatment plan that works better for you. They can also suggest ways to help you lose weight, including: Referral to a registered dietitian who can help you develop healthy eating plans that you enjoy and can help you lose pounds
Ways to incorporate exercise into your daily life and make it easier for you In addition to weight loss, exercise has many other benefits. It: Helps your immune system to function better Fights depression Builds strength and endurance Don’t let weight gain or anything else, not even the cost, stop you from sticking with your treatment. If you have trouble affording medical HIV care, Austin suggests: Contact your local health department for testing and referrals to local agencies that can connect you to care Ask your doctor’s office if you qualify for coverage through the Ryan White HIV/AIDS Program. This is a state program that helps people who are uninsured or unable to afford care, including doctor visits, medications, and support services such as meals and psychological support.
Build a Support Team Eric says that having a strong circle of friends makes a crucial difference in his life. „People should surround themselves with people who hold them accountable for a healthy lifestyle and welcome the opportunity for important and vulnerable conversations.“ He says, „I belong to a group of gentlemen living with HIV. Knowing that they’ve been living with this disease for many more years than I, gives me hope that I can lead a great life that includes not only health but also experiencing love.“