Obesity and HIV

May 2019 Council

Lead Division/Office

DDN

Point(s) of Contact

Peter Perrin, Ph.D.

Executive Summary

The prevalence of obesity in people with HIV (PWH) is increasing dramatically worldwide. Evidence suggests unique mechanisms contribute to weight gain and the development of obesity in the setting of HIV infection. These pathways might be mediated by the virus, antiretroviral therapy (ART), or both. This initiative focuses on elucidating mechanisms whereby HIV and/or antiretroviral agents interact with host processes that impact adipose tissue and weight gain or exacerbate obesity related comorbidities.

Obesity is an important emerging comorbidity in people with HIV (PWH). It is increasingly appreciated that there are unique mechanisms contributing to weight gain and obesity in PWH versus people without HIV. For example, the biology of adipocytes and adipose tissue is different in obese PWH. Several lines of evidence suggest that both viral factors and antiretroviral agents might be involved. Certain viral proteins may interact directly with adipocytes to alter differentiation, metabolism, or inflammation. The virus also might perturb other host processes, such as gastotintestinal homeostasis and barrier integrity, and subsequently have an indirect effect on adipocytes. Weight gain after the initiation of antiretroviral therapy (ART) is dependent upon the class of antiretroviral agent. Understanding these various processes and how they interact with each other is essential to preventing or reversing obesity in PWH and perhaps in people at risk for HIV on pre-exposure prophylaxis (PrEP). Moreover, how these processes impact obesity-related comorbidities is not well known.