Can taking ARVs daily cause excess weight?

QUESTION 1: Dear doctor, my sister who is HIV positive was very sick about five years ago when she was started on ARVs. She was very thin, weighing only 45kg at that time. She has greatly improved and is actually now struggling with weight at 95kg. She also has high blood pressure. Could taking ARVs daily be the cause of this excessive weight? Would a holiday from the drugs for a few months help?

Juliet

ANSWER: Dear Juliet, many people who have HIV lose weight for various reasons, which could include depression and loss of appetite for food plus recurrent diarrhea due to infections in gut and increased demand for food by the body needed to fight the infections. However, when they are counseled comprehensively, advised to eat a balanced diet and put on ARVs, they recover and put on weight. They must, however avoid over indulging because after the nutritional needs of the body have been met, the excess food taken in is converted into fat that is stored leading to overweight or obesity.

Living a sedentary life can add to the problems of such people because when one does exercise, the body mobilizes the fat to produce the extra calories or energy required. Increase in body weight means one's heart has to work harder to ensure blood reaches all parts of the body and this means it has to generate higher pressure. No wonder your sister has high blood pressure.

So, the increase in weight is not directly caused by ARVs but most likely because of her eating habits and lack of adequate exercise. That is why diseases like high blood pressure, diabetes and obesity are sometimes referred to as diseases of life style. So, she should change her lifestyle but never stop taking her ARVs.

WHEN SHOULD I REVEAL MY HIV STATUS?

QUESTION 2: Dear doctor, I recently met a man whom I love very much. He had travelled abroad to complete his studies, but will come back soon. He wants us to get married when he comes back. I am worried because I am HIV-positive and do not know how and when to tell him. I know he will want us to go for an HIV test before we go far. What is confusing is that my viral load is undetectable and recently when I went to another clinic for medical check-up, which included an HIV test, I was told it was negative though I know I have the virus because I lost my first boyfriend to AIDS and have been on ARVs for two years. My question is, when is it the right time to open up about one's HIV status to a partner?

Mercy

ANSWER: Dear Mercy, losing a boyfriend to AIDS does not necessarily mean you too have HIV. I hope you went through the right channels like being tested for HIV at a registered health facility and if you turned out HIV positive you had your CD4 count checked before starting to take ARVs. This is because after being on ARVs for some time, you can have an undetectable viral load but the HIV test would still be showing you are positive.

Being HIV negative and with an undetectable viral load may mean you have never had HIV in the first place. That is why an HIV test should always be preceded by pre-test counselling and the results given after post-test counselling by an HIV competent health service provider who is able to interpret both positive and negative results correctly. What you should do is to go for testing together with your partner at a credible health unit when he comes back and if you are still negative that should put your fears to rest.

It will also eliminate the hurdle of having to disclose your HIV status to each other since you will receive your results together.