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Life sciences · Journal article
Jaids Journal of Acquired Immune Deficiency Syndromes · September 2, 2026
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This large, propensity-matched retrospective cohort found no significant difference in mean 3-year weight change between virally suppressed PWH and matched controls (0.4 kg difference), though a higher proportion of PWH experienced ≥10% weight gain. Clinical and demographic characteristics, not ART regimen, were associated with weight gain in suppressed PWH.
Retrospective observational cohort study with multi-stage propensity score matching (4:1 ratio). Virally suppressed people with HIV and matched people without HIV from 12 US federally qualified health centers; Part A analysis included 1,296 VS PWH matched 4:1 to 4,168 PWoH; Part B focused on 10,413 suppressed PWH. Intervention: Virally suppressed people with HIV (on antiretroviral therapy). Compared with: Propensity-matched people without HIV. n = 5,464. 12 US federally qualified health centers.
Mean 3-year weight change: 0.4 kg difference between VS PWH and matched PWoH (95% CI: -0.1 to +0.9, not significant) 15% of VS PWH gained ≥10% baseline weight vs. 11% of PWoH (p<0.001) 13% of VS PWH had BMI shifts vs. 11% of PWoH (p=0.02)
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Clinicians should reassure virally suppressed PWH that weight trajectories on effective ART are similar to those in the general population; weight gain risk is driven by modifiable demographic and clinical characteristics rather than by the ART regimen itself, supporting individualized counseling on diet and exercise rather than empiric ART changes.
Large, well-matched retrospective cohort with rigorous propensity score methodology and 3-year follow-up showing no clinically meaningful difference in weight trajectories between virally suppressed PWH and matched controls, with identified demographic predictors.
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Clinicians should reassure virally suppressed PWH that weight trajectories on effective ART are similar to those in the general population; weight gain risk is driven by modifiable demographic and clinical characteristics rather than by the ART regimen itself, supporting individualized counseling on diet and exercise rather than empiric ART changes.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
BACKGROUND: Weight gain in people with HIV (PWH) has generated concern regarding metabolic consequences of antiretroviral therapy (ART). It is unclear whether weight gain differs between virally suppressed (VS) PWH and people without HIV (PWoH) when accounting for key characteristics, or which clinical and demographic factors drive weight gain in VS PWH. METHODS: This retrospective observational cohort study utilized electronic records from 12 US federally qualified health centers (January 2015-August 2023). Part A employed multi-stage propensity score matching (4:1 ratio) to compare 3-year weight trajectories adjusting for demographics, comorbidities, and medications. Part B used classification and regression trees (CART), logistic regression to identify predictors of weight gain (≥10% gain with BMI shift or baseline obesity) vs minimal gain (>0% to <5%) among 10,413 suppressed PWH. RESULTS: In matched, adjusted analyses (1,296 VS PWH; 4,168 matched PWoH), no significant difference in mean 3-year weight change was observed between VS PWH and PWoH (0.4 kg, 95% CI: -0.1 to +0.9). A higher proportion of VS PWH gained ≥10% of baseline weight compared to PWoH (15% vs. 11%, p<0.001) and increased BMI shifts (13% vs. 11%, p=0.02). Among virally suppressed PWH, significant gain correlated with younger age (median 44 vs. 51 years), female sex (28% vs. 16%), Black race (49% vs. 37%), and lower baseline BMI. No ART regimen were associated with significant weight gain. CONCLUSION: Weight change in suppressed PWH are similar to those of matched PWoH. Clinical and sociodemographic characteristics, not ART regimens, correlated with 3-year gain in VS PWH.
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