Safety and Efficacy of Weight‐Loss Pharmacotherapy in Persons Living with HIV: A Review of the Literature and Potential Drug‐Drug Interactions with Antiretroviral Therapy

Abstract

The prevalence of obesity among persons living with human immunodeficiency virus (HIV) has increased significantly and may be linked to the use of antiretroviral therapy. Although weight‐loss medications approved by the U.S. Food and Drug Administration are recommended as an adjunct to diet and exercise to treat obesity in the general population, little is known about the safety and efficacy of these drugs specifically in persons living with HIV. We review the available evidence regarding the effective use of weight‐loss pharmacotherapy in persons living with HIV and its potential to interact with antiretroviral therapy. Persons living with HIV are frequently not reported or included in clinical trials for weight‐loss medications; however, treatment efficacy is likely similar to the general population. Several important reported or theoretical drug‐drug interactions exist between antiobesity pharmacotherapy and antiretroviral therapy. Orlistat is a weight‐loss drug available in the United States without a prescription and was linked to HIV viral rebound in several case reports. Clinicians should be aware of the potential for loss of HIV viremia control when certain weight‐loss pharmacotherapies are used in combination with antiretrovirals.