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HIV infection was associated with significant weight loss before the advent of potent antiretroviral therapy (ART). Weight gain while on treatment was seen as a clinical indicator of treatment success. Perceptions of health care providers (HCPs) about obesity among people living with (PLHIV) were examined. We conducted 16 key informant interviews with HCPs in two states in southeastern Nigeria, which were then coded thematically. The respondents included seven physicians, four nurses, three adherence counselors, and two pharmacists. The analysis revealed three key themes: HCPs do not see excess weight gain as a problem; there are several challenges in managing obesity among PLHIV; and comorbidities play a role in the management of obesity among PLHIV. We conclude that obesity among PLHIV is an important clinical issue that HCPs need to address with the commencement of ART.

The proportion of people living with HIV (PLHIV) who are overweight or obese is rising, leading to a double epidemic of HIV and obesity. The purpose of this retrospective longitudinal study was to examine changes in body mass index (BMI) among PLHIV who were new to antiretroviral therapy (ART) in two states in Southeastern Nigeria. The BMI at baseline and 12 months were compared and the difference in proportions in each BMI category was tested. The association between the BMI at 12 months and the demographic and/or clinical variables was examined using multiway analysis of covariance. The study included 2,146 participants. After 12 months on ART, the number of participants who were obese increased by 135% (81 to 190), while those who were underweight decreased by 130% (306 to 133). Overall, the BMI increased in 30.2% of the participants. Further analysis showed that age (p=.009; η2=.005), baseline BMI (p<.001; η2=.435), baseline regimen (p<.001; η2=.031), HIV stage (p=.039; η2=.007) and CD4 category (p<.001; η2=.012) were all associated with increased BMI after 12 months of ART. Healthcare providers should be mindful of the likelihood of excess weight gain among PLHIV who are on ART and develop a plan to proactively address it.