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Lifesaving HIV Treatment Must Evolve to Address Cardiometabolic Risks, Experts Say
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Nearly 41 million people were living with HIV in 2024, and while antiretroviral therapy (ART) has dramatically transformed the prognosis for those infected, emerging research highlights the need for a more holistic approach to care that addresses potential long-term side effects. A growing body of evidence suggests that while ART remains essential, its impact on cardiometabolic health – including risks of high blood pressure and weight gain – requires proactive monitoring and integrated care strategies.
The Triumph of ART and the Global HIV Landscape
For decades, HIV/AIDS represented a global health crisis.However, the advent of ART has delivered “life-altering advantages,” significantly reducing mortality and improving life expectancy for people living with HIV. In 2024, approximately 21.1 million people in eastern and Southern Africa, and 5.2 million in Western and Central Africa, are living with the virus, underscoring the disproportionate impact on these regions. ART works by suppressing the virus, bolstering the immune system, and preventing the development of serious illnesses. This suppression not only improves individual health but also empowers people to fully participate in their communities, pursue education, and care for their families.
moreover, ART offers dual protection, decreasing the risk of HIV transmission during both sexual intercourse and pregnancy. this breakthrough has transformed HIV/AIDS from a death sentence into a manageable chronic condition, reducing stigma as individuals on treatment maintain visible health and activity. In Malawi, for example, life expectancy has increased from 39 years in 1990 to 64 years in 2024, largely due to the widespread availability of ART.
The Emerging Cardiometabolic Risks
Despite the remarkable success of ART, researchers are increasingly focused on its long-term effects on cardiometabolic health. Studies have shown that ART can contribute to weight gain, insulin resistance, and dyslipidemia (abnormal cholesterol levels), all of which are risk factors for cardiovascular disease. While the exact mechanisms are still being investigated, it’s believed that certain ART drugs, such as those containing tenofovir alafenamide (TAF), are associated with greater weight gain.
A study published in the journal AIDS in 2023 found that individuals who switched to a TAF-containing regimen experienced a significant increase in weight compared to those who remained on older regimens. Furthermore, weight gain, other drugs like efavirenz and tenofovir were linked to a slower, but steady, increase in heart-related risk over several years. Approximately 11.9% of patients experienced a slight worsening of heart-related risk after three years of follow-up.
However, researchers emphasized that these effects are not global.Variations in patient response are linked to factors such as age, diet, physical activity, genetics, and overall health. Notably, being female, starting treatment with a lower body weight, and maintaining good kidney function appeared to offer some protection against rising blood pressure. as individuals with HIV age and remain on lifelong treatment, maintaining heart health becomes increasingly critical, as medications can also impact cholesterol levels and contribute to inflammation.
What People Living with HIV Need to Know
The goal is not to instill fear, but to foster awareness. Individuals on ART must adhere to their prescribed medication regimen, as interruption can lead to viral resurgence, immune system weakening, and increased transmission risk. Alongside adherence, regular monitoring of weight, blood pressure, and overall wellbeing during clinic visits is paramount.
These visits provide opportunities to address concerns, ask questions, and detect changes early. Adopting healthy lifestyle habits – including regular physical activity, a diet rich in fruits and vegetables, and reduced salt intake – can further mitigate risks. These habits are accessible to everyone,irrespective of financial status,and can be integrated into daily routines. Individuals should also openly communicate any symptoms like rapid weight gain, headaches, or dizziness to their healthcare providers, recognizing these as signals for additional support, not treatment failure. Community support groups and peer counselors can also play a vital role in maintaining motivation and sharing practical health strategies.
A Call to Action for Healthcare Providers and Governments
Addressing these evolving challenges requires a shared responsibility from healthcare providers and governments. Routine monitoring for weight, blood pressure, diabetes, and heart health must become an integrated part of standard HIV care, not an added task. Clinics need the necessary tools to measure blood pressure and provide early treatment for hypertension.
Governments can support this by strengthening national guidelines, investing in healthcare worker training, and ensuring consistent access to essential medications for conditions like high blood pressure. Furthermore, investment in long-term research and monitoring systems is crucial to ensure policies remain responsive to emerging evidence. At the community level, creating safe spaces for open conversations about weight, diet, and lifestyle – free from
