Can ART cause fatigue and fat changes in men?

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

I would like to first inform you regarding Biktarvy (Bictegravir/Emtricitabine/Tenofovir Alafenamide), causing your fatigue or lipodystrophy:

Fatigue is fairly common in the first few months of ART (antiretroviral therapy) as the immune system recovers (immune reconstitution). Biktarvy itself can cause:

1. Mild fatigue.

2. Sleep changes.

3. Occasional GI (gastrointestinal) issues.

If the fatigue is not worsening and blood counts such as CBC (complete blood count), thyroid levels, vitamin D, and vitamin B12 are normal, it is usually manageable.

Lipodystrophy - True ART-related lipodystrophy is much less common with modern integrase inhibitor regimens like Biktarvy compared with older drugs such as Stavudine, Efavirenz, and Zidovudine. However, some patients do report:

1. Increased abdominal fat.

2. Facial fat loss.

3. Mild weight gain.

4. Redistribution of fat (belly, but thinner limbs).

This is usually due to:

1. Your body is recovering from HIV (return-to-health weight gain)

2. Genetics or insulin resistance.

3. Very rarely, the drug itself.

Biktarvy is one of the least toxic ART options, so switching usually happens only if the body changes become significant.

I suggest you consider using these safer alternatives:

If side effects become troublesome, I suggest you consider these common alternatives:

1. Dovato (Dolutegravir/Lamivudine):

• Two-drug regimen.

• Very well tolerated.

• Less weight gain in some studies.

• Only an option if there is no drug resistance and the viral load is already suppressed.

2. Juluca (Dolutegravir/Rilpivirine):

• Another two-drug option.
• Must be taken with food.
• Fewer metabolic effects.
• Works only after viral suppression.

3. Long-acting injections (Cabenuva: Cabotegravir/Rilpivirine);

• Monthly or every two months.

• No daily pills.

• Some patients feel better metabolically.

• Requires that you first suppress with oral medications.

These are safer only in terms of side-effect profile, not antiviral strength. Biktarvy is already extremely safe and effective.

Also, I suggest you return to your regular gym workouts. It will provide you with the following benefits:

1. Improve energy.

2. Reduce fat redistribution.

3. Maintain muscle mass.

4. Improve insulin sensitivity.

5. Boost mood and sleep.

I suggest you incorporate some of the exercises mentioned below:

1. Weight training.

2. Cardio (running, treadmill, cycling).

3. HIIT (high-intensity interval training).

4. Core or abdominal workouts.

5. Protein supplementation in normal doses.

I suggest you avoid doing exercises only in the situations mentioned below:

1. Viral load is extremely high (not your case).

2. CD4 < 200 (yours is 520, which is safe).

3. You feel severely fatigued or dizzy during exercise.

Your current numbers indicate that it is safe to resume your full routine.

I also suggest you ask your physician to check for the following:

1. Fasting glucose or HbA1c (hemoglobin A1c).

2. Lipid profile.

3. Liver function.

4. Vitamin D.

5. Thyroid function (thyroid-stimulating hormone test).

These help differentiate medication effects from other causes of fatigue or body changes.

I hope that this answers your query.

Kindly follow up if you have more doubts.

Thank you.