This series of bite-sized episodes will provide information about the cardiometabolic risk and potential for weight gain faced by patients with HIV. Tune in to hear Drs. Sorana Segal-Maurer, David Wohl, and Carl Fichtenbaum discuss the guidelines, strategies, data, and adverse events you need to be aware of to provide the best care for your patients.
Weight Creep: The Overlooked Vital Sign in Patients with HIV
Weight Creep: The Overlooked Vital Sign in Patients with HIV
Welcome to CME on ReachMD. This episode is part of our MinuteCE curriculum.
Prior to beginning the activity, please be sure to review the faculty and commercial support disclosure statements as well as the learning objectives.
This is CME on ReachMD. I’m Dr. Sorana Segal-Maurer. Here with me today is Dr. David Wohl. We’re going to dive right into this.
I’m going to be a little inflammatory – no pun intended. Is weight gain in our people living with HIV real? Is it a concern? Should we be concerned? Should we talk about it today?
Yeah, it’s amazing that years ago, those of us who have gray hair or me, no hair, remember where wasting syndrome was the predominant body shape issue that we had to deal with, and now we’re talking about people who are overweight or obese. And obesity is epidemic in our country, of course, and in other countries, of course, where there’s an ample supply of calories. So it is an issue for people living with HIV. I think it’s gotten more attention now because there has been some concern, but some of our HIV therapies, including integrase inhibitors, may contribute to weight gain. That’s controversial, and it’s a very hard thing to study. On the one hand, it’s very hard to know what to compare that to. So do integrase inhibitors make people inherently gain weight? Or are they being compared to other regimens that may inhibit weight? And we have some evidence that, for sure, some antiretrovirals do inhibit weight gain. On top of that, we have the normal phenomenon we see when we start people on HIV therapy, especially those with lower CD4 cell counts and higher viral loads, which is a dramatic increase in weight, and that “return to health.” So add that on top of all the uncertainties regarding the antiretrovirals and you’ve got this mix where it’s very confusing.
To be honest with you, Dr. Segal-Maurer, I feel that there is probably more going on with some of our therapies, including TDF and including efavirenz and maybe the pharmacological boosters, that inhibit weight and not so sure that TAF or the newer integrases really do dramatically increase weight in most people, and I think this is something that has to be teased out a little bit further. Regardless, weight gain is an issue for everyone, and there are some things we really need to talk about on how to help our patients not gain too much weight.
I want to underscore what you said. The traditional risk factors for weight gain, the not-necessarily-HIV-related risk factors, definitely genetics, age, gender. We have an intersection between HIV epidemic and the obesity epidemic, certainly in the United States in the South-Southeast, as I’m sure you are well aware of. We’re also seeing our people living with HIV get older. As older Americans who are not HIV-positive, we certainly know, as in postmenopausal women, weight gain is a tremendous challenge regardless of HIV or not. And of course, substance use or substance use cessation definitely impacts weight gain, and of course, the big topic we’re all talking about is mental health. People will self-medicate, sometimes with food, alcohol, other things, or begin medications which increase their risk for weight gain.
COVID did not do anyone any favors between social isolation and other things, but what I want to throw out there is we sometimes engage in healthy eating, but divorce the calorie intake. So we’re doing lots of great healthy eating, not minding portion size and some of what we’re putting in there. So people are frustrated because they’re eating well, but here they’re putting on weight.
And I think one thing that you mentioned – I really want to underscore, going back to you and I, hopefully we’re not the same age, but we have the same history. We look back, that CD4 nadir and the apex of that viral load really drove a lot of our lipoatrophy, lipodystrophy, and that refeeding syndrome. And I think in some of our next episodes we’ll really get into the impact of antiretrovirals on top of all of these very complex risk factors that also include lifestyle risk.
So I wanted to thank you for the points that you brought up. Certainly, we don’t have an answer on how to stop the US and global obesity epidemic, but this has been a great micro-discussion. Our time is up. Thank you so much, all, for listening.
You have been listening to CME on ReachMD. This activity is provided by Prova Education and is part of our MinuteCE curriculum.
To receive your free CME credit, or to download this activity, go to ReachMD.com/Prova. Thank you for listening.
In accordance with the ACCME Standards for Integrity and Independence, Global Learning Collaborative (GLC) requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any ineligible company. GLC mitigates all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs.
Sorana Segal-Maurer, MD
Director, The Dr. James J. Rahal Jr. Division of Infectious Diseases
Professor of Clinical Medicine
Weill Cornell Medical College, Cornell University
New York, NY
Consulting Fees: Gilead, Janssen, ViiV Healthcare
Carl J. Fichtenbaum, MD
Gregory W. Rouan Professor of Internal Medicine
University of Cincinnati
Research: Gilead Sciences, Merck & Co., Inc., ViiV Healthcare
Consulting Fees: Theratechnologies, ViiV Healthcare
David Wohl, MD
Professor of Medicine
The University of North Carolina at Chapel Hill
Chapel Hill, NC
Research: Gilead, Merck & Co., Inc., ViiV Healthcare
Consulting Fees: Gilead, Janssen, Theratechnologies, ViiV Healthcare
- Cindy Davidson has nothing to disclose.
- Ann Early has nothing to disclose.
- Keith Johnson has nothing to disclose.
- Andrea Mathis has nothing to disclose.
- Tim Person has nothing to disclose.
- Rosanne Strauss, PharmD, MBA, has nothing to disclose.
After participating in this educational activity, participants should be better able to:
- Assess cardiometabolic risk factors in patients with HIV receiving antiretroviral therapy (ART) at regular intervals
- Select antiretroviral (ARV) regimens to help protect cardiometabolic health in patients with HIV at known increased risk
- Identify benefits of some non-nucleoside reverse transcriptase inhibitors (NNRTIs) when there is a need to avoid or switch from integrase strand transfer inhibitor (INSTI)-based ARV regimens
This activity is designed to meet the educational needs of infectious disease physicians, primary care physicians, and infectious disease nurses and physician assistants.
In support of improving patient care, Global Learning Collaborative (GLC) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.
Global Learning Collaborative (GLC) designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Global Learning Collaborative (GLC) designates this activity for 1.0 nursing contact hour. Nurses should claim only the credit commensurate with the extent of their participation in the activity.
Global Learning Collaborative (GLC) has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credits. Approval is valid until 8/21/2024. PAs should claim only the credit commensurate with the extent of their participation in the activity.
Prova Education designs and executes continuing education founded on evidence-based medicine, clinical need, gap analysis, learner feedback, and more. Our mission is to serve as an inventive and relevant resource for clinical content and educational interventions across a broad spectrum of specialties.
Prova Education's methodology demonstrates a commitment to continuing medical education and the innovative assessment of its effects. Our goal is clear—to develop and deliver the very best education in the most impactful manner and to verify its results with progressive outcomes research.
This activity is supported by an independent educational grant from Merck & Co., Inc.
The views and opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of GLC and Prova Education. This presentation is not intended to define an exclusive course of patient management; the participant should use his/her clinical judgment, knowledge, experience, and diagnostic skills in applying or adopting for professional use any of the information provided herein. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients’ conditions and possible contraindications or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. Links to other sites may be provided as additional sources of information. Once you elect to access a site outside of Prova Education you are subject to the terms and conditions of use, including copyright and licensing restriction, of that site.
Reproduction of this material is not permitted without written permission from the copyright owner.
Our site requires a computer, tablet, or mobile device and a connection to the Internet. For best results, a high-speed Internet connection is recommended (DSL/Cable/Fibre). We also recommend using the latest version of your favorite browser to ensure compliance with W3C standards, such as Chrome, Safari, Firefox, or Microsoft Edge.