When you start antiretroviral therapy, a combination of drugs used to treat HIV by stopping the virus from multiplying. Also known as ART, it’s life-saving—but it doesn’t come without side effects. One of the most talked-about, yet poorly understood, is antiretroviral weight changes. Many people expect their health to improve right away, but instead they notice their body changing in ways they didn’t plan for—sometimes gaining weight fast, other times struggling to keep it on.
Not all antiretrovirals affect weight the same way. Research shows that tenofovir alafenamide, a newer version of the HIV drug tenofovir, often used in combination pills is linked to more weight gain than its older form. Dolutegravir, an integrase inhibitor known for its strong viral suppression, also shows up often in studies about unexplained weight gain, especially in women. Meanwhile, some older drugs like efavirenz, a non-nucleoside reverse transcriptase inhibitor no longer first-line but still used in some regions, were tied to weight loss or appetite loss. The body doesn’t react the same to every drug, and your genetics, diet, and activity level play a role too.
Weight gain on antiretrovirals isn’t just about looking different—it can raise your risk for diabetes, high blood pressure, and heart disease. That’s why it’s not something to ignore. If you’ve noticed your clothes fitting tighter, or your energy dropping even though your viral load is undetectable, it’s not in your head. You’re not alone. Many people on modern HIV regimens face this. The good news? You can manage it. Changes in diet, movement, and sometimes switching medications can help. What you’ll find below are real, practical guides from people who’ve been there—how to spot which drug might be causing your weight shift, what labs to ask for, and how to talk to your doctor without sounding alarmist. These aren’t theoretical tips. They’re from people living with HIV who’ve figured out how to stay healthy while staying on treatment.
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