---
title: "Weight gain in people with HIV in Africa and Asia: causes, consequences, and management"
id: "pubmed-42817201"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42817201"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42817201/"
doi: "10.1097/COH.0000000000001074"
published_at: "2026-10-01T09:57:30.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Weight gain in people with HIV in Africa and Asia: causes, consequences, and management
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42817201
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42817201/)
- **DOI:** [10.1097/COH.0000000000001074](https://doi.org/10.1097%2FCOH.0000000000001074)
- **Published At:** 2026-10-01T09:57:30.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Purpose: This review examined recent evidence (prior 18 months) on **weight gain** among people living with HIV (PLWH) in Africa and Asia to identify clinical and programmatic implications; region-specific data remain limited. - New population-level data from East Africa show the **nutrition transition** is driving weight gain faster than antiretroviral therapy (ART)–related effects; HIV-negative individuals gained more weight than PLWH on ART during the shift to **dolutegravir** regimens in rural Kenya and Uganda. - In Asian cohorts, men experienced greater weight gain after ART initiation than women, which contrasts with African cohorts where women are disproportionately affected. - Standard BMI thresholds systematically underestimate cardiometabolic risk in some Asian populations; this raises concern about interpreting weight/BMI changes clinically. - Programmatic data from Uganda linked **dolutegravir** exposure with a doubling of incident **hypertension** risk, even after adjusting for BMI change, indicating cardiometabolic consequences beyond weight alone. - ART switch trials in high-income settings (DEFINE, ACTG A5391) indicate that changing regimens does not reverse established obesity; however, a South African randomized trial (Opti-DOR) suggests the initial ART regimen influences later weight trajectory. - **GLP-1** receptor agonist therapies show strong efficacy for weight loss and cardiometabolic improvements in PLWH, including in African settings, but remain largely economically inaccessible. - Overall drivers of weight gain in PLWH in the regions include the nutrition transition, ART pharmacology, and immune reconstitution; demographic patterns differ by region and sex. - Evidence for cardiometabolic outcomes is robust in African programmatic datasets (notably hypertension), but comparable data from Asia are sparse. - Clinical and policy challenges include managing increased cardiometabolic risk, anticipating the health policy impact of limited access to antiobesity medications, and tailoring ART initiation and monitoring strategies; further region-specific research is needed.
## Clinical Analysis & Structured Key Points
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Epub 2026 Oct 1. # Weight gain in people with HIV in Africa and Asia: a review of causes, consequences, and management implications [Willem Daniel Francois Venter](https://pubmed.ncbi.nlm.nih.gov/?term=Venter+WDF&cauthor_id=42817201)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42817201/#full-view-affiliation-1 "Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa."), [Simiso Mandisa Sokhela](https://pubmed.ncbi.nlm.nih.gov/?term=Sokhela+SM&cauthor_id=42817201)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42817201/#full-view-affiliation-1 "Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa."), [Jen Manne-Goehler](https://pubmed.ncbi.nlm.nih.gov/?term=Manne-Goehler+J&cauthor_id=42817201)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42817201/#full-view-affiliation-2 "Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.") Affiliations Expand ### Affiliations * 1 Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. * 2 Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, USA. * PMID: **42817201** * DOI: [ 10.1097/COH.0000000000001074 ](https://doi.org/10.1097/coh.0000000000001074) Item in Clipboard Review # Weight gain in people with HIV in Africa and Asia: a review of causes, consequences, and management implications Willem Daniel Francois Venter et al. Curr Opin HIV AIDS. 2026. Show details Display options Display options Format Abstract PubMed PMID Curr Opin HIV AIDS Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Curr+Opin+HIV+AIDS%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Curr+Opin+HIV+AIDS%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42817201/) . 2026 Nov 1;21(6):460-466. doi: 10.1097/COH.0000000000001074. Epub 2026 Oct 1. ### Authors [Willem Daniel Francois Venter](https://pubmed.ncbi.nlm.nih.gov/?term=Venter+WDF&cauthor_id=42817201)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42817201/#short-view-affiliation-1 "Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa."), [Simiso Mandisa Sokhela](https://pubmed.ncbi.nlm.nih.gov/?term=Sokhela+SM&cauthor_id=42817201)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42817201/#short-view-affiliation-1 "Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa."), [Jen Manne-Goehler](https://pubmed.ncbi.nlm.nih.gov/?term=Manne-Goehler+J&cauthor_id=42817201)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42817201/#short-view-affiliation-2 "Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.") ### Affiliations * 1 Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. * 2 Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, USA. * PMID: **42817201** * DOI: [ 10.1097/COH.0000000000001074 ](https://doi.org/10.1097/coh.0000000000001074) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Purpose of review:** To examine weight gain epidemiology in people with HIV (PLWH) across Africa and Asia, focusing on data published in the preceding 18 months, and to identify clinical and programmatic implications, acknowledging that regionally derived evidence remains sparse. **Recent findings:** New population-level data from East Africa demonstrate that the nutrition transition is accelerating faster than ART-related weight gain. Thus, HIV-negative individuals gained more weight than PLWH on ART over the transition to dolutegravir regimens in rural Kenya and Uganda. In Asian cohorts, men gained more weight than women after ART initiation. This is the reverse of the sex-specific changes in body weight seen in Africa, and this is particularly worrisome because standard BMI thresholds systematically underestimate cardiometabolic risk in this population. Programmatic data from Uganda have shown that dolutegravir exposure doubles the risk of incident hypertension even after adjustment for BMI change. ART switch trials conducted in high-income settings (DEFINE, ACTG A5391) confirm that regimen changes do not reverse established obesity; however, emerging data from a South African randomized trial (Opti-DOR) suggest that regimen at ART initiation influences weight trajectory. GLP-1 therapies demonstrate compelling efficacy for both weight loss and cardiometabolic health improvement in PLWH, including in Africa, but remain economically inaccessible. **Summary:** Weight gain in people with HIV in Africa and Asia reflects the convergence of the nutrition transition, ART pharmacology, and immune reconstitution, disproportionately affecting women in African cohorts and men in Asian cohorts. Cardiometabolic consequences, particularly hypertension, are now robustly documented in African programmatic data, but equivalent evidence from Asia remains sparse. Switching ART does not reverse established obesity, although regimen choice at initiation influences weight trajectory. Access to antiobesity medications may be the defining health policy challenge for these populations over the next decade. **Keywords:** Africa; Asia; antiretrovirals; obesity; weight gain. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## References 1. 1. Clinton Health Access Initiative. HIV Market Report: The state of HIV treatment, testing, and prevention in low- and middle-income countries. In: Boston: 2023. 2. 1. UNAIDS. Global AIDS Update. In: Geneva: 2025. 3. 1. Pryke L, Koethe JR, Bailin S. Obesity and weight management in HIV: epidemiology, complications, and emerging treatments. Curr HIV/AIDS Rep 2026; 23:6. 4. 1. Wohl DA, Koethe JR, Sax PE, et al. Antiretrovirals and weight change: weighing the evidence. Clin Infect Dis 2024; 79:999–1005. 5. 1. Jaacks LM, Vandevijvere S, Pan A, et al. The obesity transition: stages of the global epidemic. Lancet Diabetes Endocrinol 2019; 7:231–240. 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