Weight Gain Linked to Lower Quality of Life in HIV

The adverse effects of antiretroviral therapy (ART) can confer a heavy burden on quality of life as it pertains to weight gain brought on by adherence to the medication in people living with HIV. According to a new study published in AIDS Care,¹ those who had a 5% or greater weight when using ART had a poorer quality of life compared with those who had a weight gain of less than 5%.

ART is the leading method of treating HIV, capable of reducing the viral load in the blood of those living with HIV to prolong their life to that of an individual without HIV. An adverse effect of some types of the life-saving medication, however, is weight gain, with 1 in 6 people starting ART gaining at least 10% in body weight in 1 to 2 years after starting treatment.² As quality of life is an important measure of HIV treatment, this study aimed to determine the weight gain over time and how it is associated to both quality of life and adherence to ART in people living with HIV who live in the US.

People living with HIV had a poorer quality of life with a 5% or higher weight gain on ART. | Image credit: Hunterframe - stock.adobe.com

This retrospective observational study used the Adelphi Real-World HIV Disease Specific Programme to collect data between June 2021 and July 2022. The data collected consisted of a survey that was filled out by physicians and their patient living with HIV. Primary care physicians and infectious disease specialists who took an active role in treatment of HIV were eligible for this study if they consulted with at least 5 people living with HIV per month. People living with HIV were eligible if they were 18 years or older, were prescribed ART, had a physician-confirmed diagnosis of HIV, and were virally suppressed at the time of consultation. Patients also need at least 2 measures of weight for inclusion.

Weight change was calculated by using the weight measure from the time of data collection as well as their weight at 6 and 12 months before. Individuals were split into 2 groups: those who had a 5% or higher weight gain and those who had less than 5% weight gain. The Impact of Weight on Quality of Life-Lite-Clinical Trials Version and the Adelphi Adherence Questionnaire were used to evaluate quality of life through a 20-item instrument and an 11-item patient-reported questionnaire, respectively.

There were 225 people living with HIV reported by 49 physicians who were included in the study; 24% had 5% or higher weight gain compared with 76% who had less than 5% weight gain in the previous year. The mean (SD) age of the cohort was 44.7 (12.7) years, 57.8% were White, 29.8% were Black, and 73.8% were cisgender men. Although the percentage of participants who had 5% or higher weight gain was equal between White and Black participants (42.6%), White participants made up the majority of participants who had less than 5% weight gain (62.6%) compared with Black participants (25.7%).

Participants who had 5% or higher weight gain had a higher mean Charlson Comorbidity Index (4.3 [0.8]) compared with those with less than 5% weight gain (4.1 [0.8]), with hypertension (32.9%) and dyslipidemia (27.6%) the most frequently reported comorbidities. A total of 38.2% of the participants did not take medication for their comorbidities, but antihypertensives (25.3%), statins (18.7%), and antidepressants (20.0%) were the most common medications used by those reporting treatment for comorbidities. Sleeping medication was more often prescribed to those with 5% or higher weight gain.

Significantly lower mean scores for quality of life were found in those who gained 5% or more weight in a year compared with those who gained less weight (65.6 [1.3] vs 74.4 [1.3]). Patients with more weight gain scored lower on the questionnaire compared with those with less weight gain (0.29 [0.02] vs 0.37 [0.02]), which indicated better adherence to ART.

There are some limitations to this study. Most of the participants were men, which could have skewed the results. Gender differences in weight gain and how that affects quality of life could not be properly evaluated due to the small population of women. All of the participants were consulting with a physician during the study period, which leaves out those who are not up to date on physician visits. Also, willingness to complete the survey could have affected the number of participants of the study, and onfounding factors that were not measured could have been included in the analysis.

The authors concluded that weight gain in people living with HIV had a substantial burden on their quality of life and could affect adherence to ART.

“Additional research is needed to examine changes in health-related quality of life scores over time among [people living with HIV] with and without adverse weight gain,” the authors wrote. “The findings in this study underscore the critical importance of monitoring weight and considering weight management into account when managing [people living with HIV], including the selection of appropriate ART options.”

References

1. Tadese BK, Hennessy F, Holbrook T, Prajapati G. Weight gain and health-related quality of life in people living with HIV on antiretroviral therapy in the United States. AIDS Care. Published online July 29, 2025. doi:10.1080/09540121.2025.2534116

2. Weight gain. International Association of Providers of AIDS Care. Updated March 2021. Accessed July 29, 2025. https://www.iapac.org/fact-sheet/weight-gain/