What to know about HIV and weight loss

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There are many reasons why people with HIV may experience unwanted weight loss. Possible causes include:

Opportunistic infections

Opportunistic infections (OIs) are illnesses that affect people with HIV more frequently and severely than those without HIV due to a weakened immune system.

OIs may cause weight loss in people with HIV. Effective HIV treatment means there are now fewer cases of OIs in people with HIV.

Nutrient deficiencies and low calorie intake

HIV weight loss may be due to nutritional deficiencies or not taking in enough calories, which can happen as a result of:

• neurologic disease, which may affect food intake or perception of hunger
• food insecurity due to psychosocial or financial issues
• malabsorption of nutrients due to nausea or diarrhea
• problems with the mouth or OIs making it more difficult to chew or swallow
• gastrointestinal issues, which may affect the absorption of nutrients or make people feel full more quickly

Metabolism changes

Research has found a link between HIV weight loss and changes in metabolism. This may be due to:

• changes to metabolic demands
• cytokine dysregulation, which is a change in proteins involved in cell signaling
• hormonal changes

Hypogonadism is a condition where the sex glands do not produce enough sex hormones. According to the 2016 article, hypogonadism can cause weight loss in up to 50% of people with HIV.

Resting energy expenditure (REE) is the rate at which people burn calories when resting. In people with HIV who do not receive treatment, REE is roughly 10–35% greater than in people without HIV, and it may be even higher for people with HIV and OIs.

Mental health conditions

According to the National Institute of Mental Health, people living with HIV may have a higher risk for mental health disorders, particularly depression. Factors that may contribute to this include:

• the stress of living with a chronic condition
• stigma associated with HIV
• difficulty accessing healthcare or mental health services
• loss of social support or employment
• managing HIV treatments or side effects of medication

Mental health conditions such as depression may cause people to lose their appetite or enjoyment of food.

HIV medications

Certain HIV medications may cause people to lose their appetite, change how food tastes, or affect how the body absorbs nutrients.

Some may also cause fatigue, which may make preparing meals and eating regularly more difficult.

Lipodystrophy

The HIV infection or side effects of older HIV medication may cause lipodystrophy. Lipodystrophy is a condition where people have fat changes in the body. This can include gaining and losing fat.

People may gain fat in areas such as:

• the abdomen
• at the back of the neck, between the shoulders
• the breasts

People may lose fat in areas such as the following:

• arms and legs
• buttocks
• face

However, lipodystrophy is much less of a concern for people receiving treatment for HIV with new medications than it may have been previously.

According to a 2020 article, some antiretroviral medications, such as integrase strand transfer inhibitors and tenofovir alafenamide, may cause weight gain.

Another 2020 article suggests that people with HIV who receive antiretroviral treatment gain weight faster than HIV-negative people. Gaining excess weight could have negative health consequences, as having obesity increases a person’s risk for:

• type 2 diabetes
• high blood pressure
• high levels of fat in the blood
• heart disease
• inflammation

Unless people are underweight, it is advisable for them to aim to minimize any weight gain while taking antiretroviral medication.

If people carry excess weight or have obesity, losing a certain amount of weight may be healthy. People can talk to their care team about the safety of losing weight with HIV.

A healthy, nutritious diet is important in helping to prevent unwanted weight loss with HIV. People with HIV may need a diet that is higher in calories and protein than people without HIV. This can help prevent the loss of muscle mass.

People may want to add the following foods to their meals to increase protein intake:

• peanut butter or other nut butters
• legumes, such as beans and peas
• cottage or shredded cheese
• eggs
• protein shakes and milkshakes
• nuts and seeds
• yogurt
• fish, such as canned tuna
• meat

People can add moderate amounts of the following foods to increase calorie intake:

• butter
• salad dressing
• sour cream
• cream cheese
• avocado
• olive oil

People can also increase their intake of carbohydrates and starches, such as:

• potatoes
• rice
• pasta
• fresh and dried fruit
• oatmeal
• bread
• crackers

The following tips may also help people to improve appetite and prevent unwanted weight loss while living with HIV:

• doing resistance and weight lifting exercise to build and maintain muscle mass
• making food enjoyable and tasty to eat
• eating smaller meals more frequently throughout the day, rather than larger ones
• drinking high-calorie protein shakes between meals
• avoiding citrus, spicy, or very hot or cold foods if the mouth is sore
• eating bland foods for an upset stomach

People may also want to work alongside their care team to work out a diet and exercise regime to maintain a healthy weight.

Treatment for HIV weight loss may include the following:

• appetite stimulant medication
• anabolic agents, such as testosterone or human growth hormone, to increase weight gain
• anti-nausea medication
• cytokine production modulators, such as thalidomide, but only in rare cases due to side effects

If a medical professional suspects HIV medications are causing unwanted weight loss or gain, they may suggest a change in medication.

Where a mental health condition is affecting appetite, treating the condition may help. People can talk to their care team about their mental health and discuss treatment options.

If people have lipodystrophy, they can discuss treatment options with a doctor. Treatments for this may include:

• switching HIV medication
• dietary changes
• regular exercise
• medications to reduce lipodystrophy
• surgical removal of fat
• injectable facial fillers

People with HIV may have unwanted weight loss for several reasons, such as opportunistic infections, hormonal and metabolic changes, or side effects of HIV medication.

Emotional factors, financial factors, and mental health conditions can also play a role in access to food or loss of appetite.

Increasing calorie and protein intake, exercising to build muscle, and taking certain medications can all help to prevent unwanted weight loss.