Department of Infectious diseases, CHU UCL Namur, Yvoir.
Department of Internal Medecine and Infectious diseases, Cliniques Universitaires Saint-Luc (UCLouvain), Bruxelles. Belgium.
AIDS Rev. 2022;25(3):122-132. doi: 10.24875/AIDSRev.21000092.
The prevalence of obesity has increased dramatically in recent decades worldwide. An increase in the prevalence of obesity has also been observed among people living with HIV (PLHIV) in high and low incomes countries. Antiretroviral therapy (ART), by controlling the viral load (VL) and restoring cellular immunity, has improved the health status and life expectancy in PLHIV. However, the risk of developing non-AIDS events (NAEs) remains higher than the general population. Therefore, specific attention is given to managing risk factors associated with NAEs during the follow-up of PLHIV, including obesity. Factors related to weight gain in PLHIV include demographic factors, HIV disease-related factors, and ART-associated factors. In naive PLHIV, weight gain after the initiation of ART is expected. The weight gains observed are generally not severe even if there appear to be risk factors such as the advanced stage of disease (low CD4 cells count and high VL), female sex, black race, and taking integrase strand transfer inhibitors (INSTI) associated or not with tenofovir alafenamide fumarate (TAF). The role of each antiretroviral drug per-se remains to clarify. As INSTI ± TAF has been associated with significant weight gain, further research is needed to identify the individual-level factors predictive of weight gain, the mechanisms of ART-associated weight gain and the clinical relevance of this weight gain. As PLHIV survive longer on effective ART, the prevention and management of NAEs will remain a challenge for healthcare providers.
近年来，全球肥胖的患病率显著增加。在高收入和低收入国家，艾滋病毒感染者（PLHIV）的肥胖患病率也有所上升。抗逆转录病毒疗法（ART）通过控制病毒载量（VL）和恢复细胞免疫，改善了 PLHIV 的健康状况和预期寿命。然而，与普通人群相比，PLHIV 发生非艾滋病事件（NAE）的风险仍然更高。因此，在 PLHIV 的随访过程中，除了关注非艾滋病事件（NAE）外，还要特别注意管理与 NAE 相关的风险因素，包括肥胖。PLHIV 体重增加的相关因素包括人口统计学因素、HIV 疾病相关因素和 ART 相关因素。在未接受过治疗的 PLHIV 中，ART 起始后体重增加是预期的。观察到的体重增加通常不严重，即使存在疾病晚期（低 CD4 细胞计数和高 VL）、女性、黑人种族以及使用整合酶抑制剂（INSTI）等危险因素，与或不与富马酸替诺福韦二吡呋酯（TAF）联合使用。每种抗逆转录病毒药物的作用仍需进一步阐明。由于 INSTI ± TAF 与显著的体重增加有关，需要进一步研究以确定预测体重增加的个体因素、ART 相关体重增加的机制以及这种体重增加的临床意义。随着 PLHIV 在有效的 ART 下存活时间更长，NAE 的预防和管理仍将是医疗保健提供者面临的挑战。
