When you start taking dolutegravir, a widely used integrase inhibitor for treating HIV. Also known as DTG, it’s a key part of modern antiretroviral therapy because it stops the virus from multiplying fast and keeps viral loads low. But many people starting dolutegravir notice something unexpected — they’re gaining weight, even when their diet and activity levels haven’t changed. This isn’t just anecdotal. Studies, including data from the WHO and U.S. CDC, show people on dolutegravir-based regimens gain more weight on average than those on older HIV drugs like efavirenz or tenofovir DF.
This weight gain isn’t just about the pill itself — it’s tied to how your body reacts when the virus is finally under control. Before treatment, HIV can cause chronic inflammation and metabolic stress, which often leads to weight loss or muscle wasting. When dolutegravir shuts down the virus, your immune system starts to recover, and your body begins storing fat again — sometimes too much, too fast. It’s not that dolutegravir makes you hungry; it’s that your metabolism shifts back into normal mode, and fat storage kicks in harder than before. antiretroviral therapy, the combination of drugs used to manage HIV is now more effective than ever, but that success comes with new challenges like weight gain, insulin resistance, and changes in fat distribution.
Not everyone gains weight on dolutegravir — some people stay the same, others lose a little — but the trend is strong enough that doctors now monitor weight closely during the first 6 to 12 months of treatment. If you’re on dolutegravir and notice your clothes fitting tighter, your waistline expanding, or your energy dipping despite eating the same, it’s worth talking to your provider. This isn’t a reason to stop your meds — control of HIV is still the top priority — but it’s a sign you might need help adjusting your diet, adding movement, or even switching to a different drug if the gain becomes unhealthy.
There’s also a connection between dolutegravir and other HIV medication weight gain, a growing concern in long-term HIV care. Newer drugs like bictegravir and cabotegravir show similar patterns, suggesting this might be a class effect — not just a quirk of one drug. Older drugs like tenofovir DF were linked to fat loss, while older protease inhibitors caused belly fat buildup. Dolutegravir is different: it tends to add fat evenly, especially around the waist and hips, and it’s more common in women and people of African descent.
If you’re on dolutegravir and worried about weight, you’re not alone. Thousands of people are asking the same questions. The good news? You don’t have to just accept it. Small changes — like adding daily walks, cutting back on sugary drinks, or tracking portions — can make a real difference. And your doctor can help you decide if switching to another drug makes sense, especially if you’re also dealing with high cholesterol, diabetes, or high blood pressure.
Below, you’ll find real patient experiences, clinical insights, and comparisons with other HIV drugs to help you understand what’s happening to your body — and what you can do about it. No fluff. No jargon. Just clear, practical info to help you stay healthy on your treatment plan.
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