Figure 1.

Proposed model of obesity in persons with HIV (PWH). Contemporary antiretroviral therapy agents (principally integrase strand transfer inhibitors and tenofovir alafenamide), an obesogenic environment (high-fat diet and physical inactivity), shifting demographics, and an aging population predispose to obesity. Obesity in persons with HIV results in increased inflammation, increased ectopic lipid disposition, and alterations in lipid and glucose metabolism. This contributes to metabolic complications including diabetes mellitus, neurocognitive impairment, and hepatic disease. The link between obesity as measured by body mass index and cardiovascular disease is not completely understood.