The physiological effects of obesity in HIV-infected patients

Barely two decades ago, HIV disease deemed a terminal illness accompanied by severe wasting. Today, HIV disease has become a chronic illness, largely due to the success of highly active antiretroviral therapy (ART). In the U.S., this increased longevity has naturally led to HIV-infected persons becoming increasingly overweight and obese, with rates of weight excess similar to that of the general population. This article reviews existing literature on the impact of obesity on HIV-infected patients, and the management of obesity with a focus on older persons. Weight excess in the general and HIV-infected populations is associated with adverse medical conditions, such as hypertension, dyslipidemia and diabetes mellitus. Obesity in HIV-infected patients, and particularly older patients, is associated with decline in physical function and frailty. However, more research is needed to fully understand the complications of obesity in HIV-infected patients and its pathophysiologic mechanisms. Clinicians should be aware of these trends with respect to obesity in this population, and consider implementing customized weight management programs as part of routine HIV care. In that respect, future research is sorely needed to develop evidence-based guidelines to manage obesity in HIV-infected patients, and particularly those who have functional impairments or medical complications that can benefit from customized weight management programs.