Frank J. Palella, MD: Concerns about weight gain in association with antiretroviral therapy have emerged over the last several years since the advent of the second-generation integrase strand transfer inhibitor antiretrovirals. From multiple interventional and observation studies of large diverse populations of persons with HIV, we’ve learned that for both treatment-naїve individuals or virally suppressed persons who are switching to these therapies, weight gain can occur often in excess of what we’d consider to be a return to health for treatment-naїve persons.

This weight gain can constitute a concern medically, functionally, and cosmetically. A concern on the part of the provider in terms of the potential for weight gain to put patients in a category where they’re clearly overweight, and potentially then increase the risk for weight-gain-associated, noninfectious comorbidities like insulin-resistance diabetes, hyperlipidemia, hypertension, cardiac illness, fatty liver disease or liver inflammation, as well as a host of other metabolic conditions.

We need to proactively talk about weight gain to patients who are initiating therapy or patients who are switching. The data that have emerged suggest that there are certain ethno-demographic characteristics of patients that might put them at greater risk. Women, particularly women of color, appear to be at the greatest risk for not only weight gain but the greatest amount of weight gain upon initiation of therapy. Because we’re aiming toward the optimization of overall health in treating HIV, we have to discuss openly and transparently with the patient and consider in the balance what we determine to be the overall risk-benefit ratio of initiating different therapies, and to engage our clients in these discussions as to what might work best for them, what we will be monitoring them for—including weight gain once therapy is initiated—and what steps we might take if we encounter a situation in which excess weight gain is encountered, including alteration of therapy.

Transcript edited for clarity.