HIV treatment has delivered life-altering advantages. Antiretroviral therapy has led to a reduced mortality and improved life expectancy for people living with HIV. Nearly 41 million people were living with HIV in 2024. Eastern and southern Africa accounted for 21.1 million while western and central Africa accounted for 5.2 million.

But there are risks associated with the therapy , including the potential for a set of health conditions affecting heart, blood vessels, and metabolisms like high blood pressure and excessive weight gain.

Melani Ratih Mahanani, a medical doctor and epidemiologist, unpacks her research conducted in Malawi that showed some drugs have some side effects but that weight gain or high blood pressure following HIV treatment does not mean treatment is failing or dangerous. Instead, these patterns simply show that HIV care and chronic disease care need to work together.

How important is antiretroviral therapy for people living with HIV?

Modern HIV care depends on antiretroviral therapy as its fundamental component. Antiretroviral therapy is a variety of pills that treats HIV by stopping the virus from making copies of itself. Antiretroviral therapy protects viral suppression while it supports immune system defence and prevents serious illnesses from developing. The suppression of HIV virus enables people to experience better health while gaining more energy to work, study, care for their children, and actively participate in their communities.

Antiretroviral therapy provides dual protection to both patients and their partners. It decreases the transmission risk of HIV during sex and pregnancy. With it, medical scientists have achieved breakthroughs in HIV treatment turning HIV/AIDS into a condition that can be managed long-term. Treatment provision in various communities has decreased unfair treatment and judgment to those with HIV because people on treatment remain visibly healthy and active.

With consistent daily use, antiretroviral therapy allows individuals to live long. Malawi’s life expectancy was 66.04 years in 2022 but is now 66.37 years in 2025.

It not only protects individuals’ health, but strengthens families and communities.

The advantages of antiretroviral therapy exceed potential side effects which appear during extended medication use. Nevertheless, it does have an impact on cardiometabolic health like high blood pressure and excessive weight gain.

What risks did your research uncover?

A total number of 432 people living with HIV were involved in the research, 317 were females. Dolutegravir is recommended in WHO guidelines and has reportedly been associated with excess gain in body weight, our objective was to determine the veracity of this. We retrieved data on body weight and systolic blood pressure of the 543 people who were on other drugs - tenofovir and lamiduvine - before switching to dolutegravir.

Blood pressure: From a total of 432 patients followed, newly diagnosed hypertension was found in 11% after dolutegravir switch, compared to 5.4% when they were on the previous antiretroviral therapy medications. Other drugs, such as efavirenz and tenofovir, were linked to slower but steady increases in heart-related risk over several years. In about 24 out of 201 patients (11.9%), the heart-related risk slightly worsened after three years of follow-up.

Weight gain: We found that this was minimal after dolutegravir.

The effects of weight gain and high blood pressure do not affect all patients who receive antiretroviral therapy treatment. Most patients who receive these medications experience no significant changes in their weight or blood pressure levels and only few are affected. The variations between patients stem from their age, diet, physical activity, genetics, and overall health.

For example, we found that there were exceptions to the side effects because different patients can react in different ways. Patients who experienced weight gain during HIV treatment and those who entered the study with elevated blood pressure levels developed higher blood pressure during the study period. In contrast, being female, starting treatment with a lower body weight, and having good kidney function seemed to protect against rising blood pressure.

As people living with HIV grow older and remain on lifelong treatment, heart health become more important. High blood pressure and excessive weight gain are part of the reasons, but some HIV medications can also affect cholesterol levels. They can cause inflammation in the body or change how the body handles fats and sugars.

What should people taking ART be aware of?

Our aim was not to create fear about HIV medicines but to encourage awareness.

People with HIV must keep taking their antiretroviral therapy medication daily as prescribed by their doctor because stopping treatment will cause the virus to rise, weaken the immune system, and increase the risk of passing the virus to others. Alongside staying adherent, it is important to monitor weight, blood pressure, and overall wellbeing during routine clinic visits.

Regular clinic visits are an opportunity to check overall health condition, ask questions, and catch any changes early.

People living with HIV can support their own health by adopting healthy habits, such as regular physical activity, adding more fruits and vegetables to meals, and reducing salts. They must also avoid smoking and excessive alcohol which can help reduce the risk of weight gain and high blood pressure.

They can practice these healthy habits through their regular activities without spending money on equipment or gym memberships. These habits can be practiced by everyone regardless of their financial situation during their everyday activities.

It is also important for them to speak openly with healthcare providers if they notice rapid weight gain, headaches, dizziness, or other symptoms. These are not signs for treatment failure but signals that additional support might be needed.

Community support groups and peer counsellors can also help people living with HIV stay motivated and share practical ways of staying healthy on antiretroviral therapy.

People living with HIV should stay on treatment, stay informed, and stay connected to care.

What should be the response of healthcare providers and governments?

Healthcare providers and governments have a shared responsibility to ensure that HIV care addresses both viral suppression and long-term wellbeing. This means making routine monitor for weight, blood pressure, diabetes, and heart health part of standard HIV care. This should not be seen as extra task, but as integrated, normal parts of care.

Clinics should have the tools to measure blood pressure and offer early treatment for hypertension when needed.

Governments can support this by strengthening national guidelines, providing training for health workers, and ensuring that essential medicines for conditions like high blood pressure are consistently available.

Additionally, governments should also invest in research and long-term monitoring systems, so policies remain responsive to emerging evidence.

At the community level, health facilities can create safe spaces for conversations about weight, diet, and lifestyle without judgment or stigma. Public health campaigns can help people understand that gaining weight after starting antiretroviral therapy is common and manageable, and that monitoring health is a sign of good care.

By integrating HIV care with non-communicable disease prevention and care, healthcare systems can help people living with HIV remain healthy across their lifespan.

This article is republished from The Conversation, a nonprofit, independent news organization bringing you facts and trustworthy analysis to help you make sense of our complex world. It was written by: Melani Ratih Mahanani, University of Heidelberg

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Melani Ratih Mahanani receives funding from the Federal Ministry of Research, Technology and Space of Germany.