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Beyond Measure Managing weight gain and HIV

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Bay Watch

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Oakland long-term survivor Kehn Coleman

San Francisco and Oakland sit on different sides of the same bay. But when dealing with AIDS, they are worlds apart. Rich, experienced, largely white San Fran meets HIV head-on, while underfunded, understaffed and heavily African-American Oakland battles the epidemic underground— or out on its streets. How Oakland became the new epicenter for the black AIDS epidemic.

Former pop star and former heroin addict Sherri Lewis has been to the brink and back during her 20-year trip with HIV. Today, the new media maven jolts people into awareness with her podcast, Straight Girl in a Queer World. Oh, Sherri!

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Louder Than Words Healing through artistic activism Life Altering Spencer

Eric Rhein

for AIDS activist Spencer Cox, 1968–2012 from Leaves, an AIDS memorial, by Eric Rhein

EMPOWERING THE HIV COMMUNITY SINCE 1994

FROM THE EDITOR

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CONTENTS

’VE NEVER BEEN WHAT MOST people would call a thin person. There was a time in the late 1980s when I had a consistent size 30 waist. Let’s just say that changed as I got older. When it comes to the subject of weight, we are all a bit sensitive. Not only are we dealing with our health and self-image, but we are also reacting to the judgment of others. Being comfortable in our skin is always a challenge; carrying excess weight doesn’t make it any easier. For those of us living with HIV who have access to health care, staying in good health usually includes taking antiretroviral medications. These HIV meds keep the virus in check, which is vital. If we reach and maintain an undetectable viral load, we can’t transmit HIV via sex. Taking our HIV meds is nonnegotiable. So it is particularly frustrating that some HIV meds are linked to weight gain. Attention to this issue has increased in the past few years. Researchers haven’t figured it all out yet, but they are finding out more all the time. That is why we have dedicated this special issue to understanding weight gain. Lepena Reid knows something about this topic. A lot, actually. By her count, the long-term survivor has gained 20 pounds in the past two years, despite eating healthy. Her physician has switched her HIV meds as a result. Go to page 6 to read more about her journey. For many of us, the reasons for gaining weight aren’t always clear. Years ago, I gained weight after switching HIV meds. I had never considered until very recently that the meds could have played a role. I managed to slowly drop the weight, and I have changed meds since then, so the mystery will remain. Robert Gillum is going through something similar. He says he gained 20 to 25

pounds in the past three years after he switched meds. His doctor can’t confirm or deny whether his current treatment is to blame, but they are discussing changing his meds. Go to page 9 for more. Regardless of the reasons for weight gain, there are related health risks. Weight gain has been linked to health problems ranging from cardiovascular disease and diabetes to cancer and cognitive decline. Go to page 5 to learn more. The good news is that managing weight gain is possible. A healthy diet and exercise are key to controlling excess weight. There is one thing that you shouldn’t do: delay or stop your HIV treatment. Go to page 8 for more. Weight gain isn’t as simple as it seems. Generalized weight gain among people living with HIV is often due to the same factors that cause those who are HIV negative to put on pounds. Go to page 4 to discover there is much more to the story.

ORIOL R. GUTIERREZ JR. EDITOR-IN-CHIEF editor-in-chief@poz.com

Want to read more from Oriol? Follow him on Twitter @oriolgutierrez and at blogs.poz.com/oriol.

3 FROM THE EDITOR

4 FEATURE

6 PROFILE

9 PROFILE

Understanding weight gain

Some HIV meds are linked to weight gain, but we don’t yet know why.

Lepena Reid confronts weight gain related to HIV treatment.

Aging with HIV isn’t slowing down Robert Gillum.

WEIGHT GAIN POZ FOCUS 3

Weight Gain and HIV Some HIV meds are linked to weight gain, but we don’t yet know why. By Liz Highleyman

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The more common generalized weight gain—seen in HIVpositive and HIV-negative people alike—involves an increase in both internal abdominal fat and subcutaneous fat beneath the skin, often around the belly, hips and thighs. Some people gain lean muscle mass as well. In part, generalized weight gain among people with wellcontrolled HIV reflects the fact that HIV-positive people have the same lifestyle risk factors as the HIV-negative population, including an unhealthy diet and inadequate physical activity. But unexpected weight gain among people starting antiretrovirals—often several pounds in a short period—appears to be a different problem, and it may have little connection to how much people eat or exercise. Excess body weight, and especially visceral fat gain, are linked to a host of health problems, ranging from cardiovascular disease to cognitive impairment (See “Health Risks of Weight Gain” on page 5). What’s more, weight gain can have a negative effect on self-esteem, contribute to depression and leave people less willing to start or stay on antiretroviral treatment. Thus, managing weight gain has become a key focus in the HIV field.

What Do We Know? After the advent of effective HIV treatment in the mid-1990s, lipohypertrophy was initially blamed on early protease inhibitors, some of which can cause metabolic abnormalities that contribute to fat gain. But it soon became clear that this was not the whole story. A study by John Koethe, MD, of Vanderbilt University Medical Center in Nashville, and colleagues analyzed weight

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n recent years, there’s been a growing recognition that weight gain is common among people with HIV who are on modern antiretroviral therapy. Much remains to be learned about the causes of HIV-associated weight changes, but in the meantime, you can take steps to manage weight gain and minimize its health consequences. Overweight and obesity are growing problems in the United States and worldwide due to the increased availability of highcalorie food and decreased physical activity. Experts estimate that as many as 70% of Americans are overweight. And people living with HIV have not been spared. “Weight gain certainly has been a very big issue in the HIV research world for the last two years,” says Monica Gandhi, MD, MPH, the medical director of Ward 86, the HIV clinic at Zuckerberg San Francisco General Hospital. “It’s a very consistent finding that’s been reported at conference after conference.” In the early years of the epidemic, wasting syndrome, or overall loss of both fat and lean muscle mass, was a hallmark of AIDS. After the advent of effective antiretroviral treatment, weight gain was often a sign of a return to health. But today, excessive weight gain is a more common problem. One study found that more than half of HIV-positive people on long-term treatment struggle with overweight or obesity. People with HIV may experience different types of weight gain. One type, known as lipohypertrophy (part of lipodystrophy syndrome), involves the buildup of visceral fat deep within the abdomen, resulting in a hard belly. Today, lipodystrophy is most often seen among people who have lived with HIV for a long time and used older antiretrovirals.

gain among more than 14,000 people in the North American NA-ACCORD cohorts who started treatment between 1998 and 2010. They found that 22% of people progressed from a normal body mass index (BMI) to overweight, and 18% went from overweight to obesity, within three years after starting treatment. A more recent analysis of over 8,000 HIV-positive Kaiser Permanente members who began treatment after 2006 found that while people with HIV were less likely than their HIVnegative counterparts to be overweight or obese at the start of the study, they gained weight faster—0.5 pounds versus 0.2 pounds per year, on average, over 12 years of follow-up. More rapid weight gain among people with HIV is a concern because it will likely worsen health conditions, such as cardiovascular disease, that are already more common among those living with the virus, according to Michael Silverberg, PhD, MPH, of Kaiser Permanente Northern California. Weight gain can occur after starting any class of antiretroviral drugs, but some of the newest highly potent and easily tolerated meds are the most common culprits. The late-stage clinical trials that led to the approval of modern antiretrovirals did not report weight gain as a side effect. However, many of these studies did not systematically record weight, BMI or the presence of overweight or obesity at baseline and after treatment initiation. This started to change after the new drugs came into widespread use. In 2017, a short research letter in the journal AIDS described weight gain as an “unexpected bothering side effect” of the integrase inhibitor dolutegravir. Soon thereafter,

reports of excess weight among people starting integrase inhibitors began to snowball, and today, weight gain is a major topic at HIV conferences. Along with integrase inhibitors, the newer tenofovir alafenamide (TAF) is more often associated with weight gain than the older tenofovir disoproxil fumarate (TDF). TDF protects against weight gain and blood lipid abnormalities, while TAF does not have this effect. Combining drugs that promote weight gain can have an additive effect: Dolutegravir plus TAF has been linked to the biggest gains. Another study by Koethe and colleagues pooled data from more than 5,600 people who started treatment in eight large clinical trials sponsored by Gilead Sciences between 2003 and 2015. They found that weight gain was greater in more recent studies and in those that tested newer regimens. Nearly half of the participants experienced at least a 3% gain in body weight, more than a third had at least a 5% gain and nearly one in five had at least a 10% gain during the two years after starting treatment. Overall, the average gain was just over 4 pounds. But when broken down by specific drug class, those who started on integrase inhibitors gained about 7 pounds compared with about 4 pounds for those who used either non-nucleoside reverse transcriptase inhibitors (NNRTIs) or protease inhibitors. Among the integrase inhibitors, the average gain was about 9 pounds with dolutegravir or bictegravir versus 6 pounds with elvitegravir. Among those who started NNRTIs, the average gain was nearly 7 pounds with rilpivirine (continued on page 7)

Health Risks of Weight Gain Overweight and obesity are linked to a host of health problems. Weight gain, especially an increase in visceral abdominal fat, has been linked to health problems ranging from cardiovascular disease and diabetes to cancer and cognitive impairment. But the risks of weight gain associated with antiretroviral therapy must be balanced against the many benefits of prompt HIV treatment. Chronic HIV infection—even in people on effective treatment—triggers persistent immune activation and inflammation, which raises the risk for health conditions including heart, liver and kidney disease. Inflammatory cytokines, or chemical messengers produced by immune cells, can promote fat accumulation. Fat tissue produces its own cytokines and hormones, which, in a vicious cycle, can lead to more inflammation. Weight gain often goes hand in hand with metabolic syndrome—a cluster of conditions including excess abdominal fat, high blood sugar, abnormal cholesterol and triglyceride levels and high blood pressure—which raises the risk for diabetes, heart attacks and strokes. Visceral fat can build up around the heart and inside the liver and other organs. Fat in the liver can lead to cirrhosis, liver cancer and the need for a liver transplant. Some experts now refer to non-alcoholic fatty liver disease (NAFLD) as metabolic-associated fatty liver disease (MAFLD) to emphasize the connection. Weight gain contributes to other types of cancer as well. According to the Centers for Disease Control and Prevention, overweight and obesity raise the risk for at least 13 different malignancies, including breast, colon,

kidney and pancreatic cancer. Overweight and obesity are also implicated in pregnancy complications. Using data from the ADVANCE study in South Africa, Andrew Hill, PhD, of the University of Liverpool in England and colleagues calculated that for every 1,000 pregnant women who used dolutegravir plus tenofovir alafenamide fumarate (TAF)—the combination that caused the most weight gain—there could be an additional 77 adverse birth outcomes. However, it’s not yet clear whether weight gain linked to HIV treatment will lead to the same health problems as overweight and obesity in the population at large. In the ADVANCE study, 8% of people who started treatment with dolutegravir plus TAF developed metabolic syndrome. But Hill’s team calculated that while people in this group were more likely to develop diabetes, their 10-year risk for a heart attack or stroke remained low. In an analysis of eight large trials of first-line HIV treatment, changes in blood sugar, harmful blood lipids and blood pressure did not differ significantly between people who experienced a weight gain of less than 10% and those who gained more. High blood sugar and diabetes were uncommon, but researchers cautioned that two years of follow-up might not be enough to see the full consequences of weight gain. —LH

WEIGHT GAIN POZ FOCUS 5

For Good Measure HIV advocate Lepena Reid confronts weight gain. Lepena Reid tested HIV positive in 1988, after spending the early ’80s caring for friends and others living with the virus and working with AIDS organizations. “I didn’t start medications until about 15 years later,” says Reid, a 63-year-old advocate living near Tampa. “The reason was because many of the friends I saw were on [older drugs], and they were dying.” Reid didn’t begin taking meds until 2002, when she ended up in the hospital with pneumonia. HIV aside, the worst health problem she’d experienced before that was an occasional cold. “I always ate healthy and exercised spiritually,” she explains. “I always had my belief in my faith. I just had that will to live.” Reid’s HIV treatment has resulted in some physical changes—she has gained weight. By her count, she’s put on 20 pounds in the last two years. In 2018, Reid and her doctor decided to switch her to a single-tablet regimen to reduce her pill burden. At one point, she had been taking three pills daily. After the switch, Reid began to gain weight. She told her doctor and started doing research. She spoke with other people in the HIV community who shared their own experi-

6 POZ FOCUS WEIGHT GAIN

ences with weight gain. She also learned that one component of the tablet—tenofovir alafenamide (TAF)—was associated with weight gain. In addition, the pill contains an integrase inhibitor, another possible culprit. “I really eat healthy,” she explains. “I don’t drink alcohol, smoke or none of those things. My diet hadn’t changed, but my weight was increasing.” Her new weight has made her feel uncomfortable and larger overall. “I’m very disappointed with my appearance right now,” she says. “When I look at myself and how my clothes fit on me, I don’t feel good about it.” Nevertheless, Reid has kept up her wellness habits. She regularly eats vegetables, makes her own juices and walks twice a day. She doesn’t eat seafood but does sometimes enjoy chicken. Even so, she still hasn’t lost any weight and considers her belly a problem area. After observing no decrease in her weight, her specialist recently switched her HIV treatment to a different single-tablet regimen that does not include TAF but does contain an integrase inhibitor. Although she hasn’t shed any pounds

yet, she is optimistic about the future. “I hope I can go back to my doctor soon, and they’ll do something else because these 20 pounds are just not comfortable for me,” Reid says. What’s more, Reid is very worried about developing dementia, as she has a family history of the condition. She also knows HIV can affect brain function and lead to HIV-associated neurocognitive disorders. Otherwise, Reid isn’t too concerned about her health. Despite the ongoing COVID-19 crisis in the United States, Reid continues to facilitate support groups for women living with HIV, albeit via telephone. She also crafts red ribbon earrings—to raise awareness and support for HIV-positive people—as well as other jewelry as a member of Common Threads, a crafting collective of women living with HIV. Reid plans to continue celebrating life—whether she’s spending time at the beach, crafting, skydiving, laughing or advocating for people living with HIV. “I’m still alive,” Reid says. “If you’re alive, you have a possibility to do and create, and that’s what I want to continue to do as long as I live. I’m doing the best each and every day that I can for myself and my community.”

BRYAN REGAN

By Alicia Green

versus 4 pounds with efavirenz. And among the nucleoside/ nucleotide reverse transcriptase inhibitors, the average gain was about 9 pounds with TAF, nearly 5 pounds with TDF and nearly 7 pounds with abacavir. A larger NA-ACCORD analysis of nearly 23,000 people starting first-line treatment found that those who used integrase inhibitors or protease inhibitors gained an average of about 12 pounds after five years on treatment, compared with about 8 pounds for those who started NNRTIs. Here, too, those who started dolutegravir saw the greatest gains: nearly 16 pounds on average. “Our findings raise the possibility that modern antiretroviral therapy regimens with improved tolerability and potency may lead to weight gain in some people living with HIV, necessitating increased clinical attention to the maintenance of healthy body weight, lifestyle modification and exercise at [treatment] initiation,” Koethe and colleagues concluded. Like people starting treatment for the first time, those who switch regimens may also gain weight. Another NA-ACCORD analysis found that among 870 people who switched treatment and maintained a low viral load, switching from an NNRTI to an integrase inhibitor was linked to more weight gain, driven primarily by dolutegravir. A study of the OPERA cohort included more than 115,000 people in 65 U.S. cities who were taking a three-drug regimen containing TDF. Those who switched from TDF to TAF without changing their other meds gained an average of about 5 pounds during the ensuing nine months, regardless of the other drugs in their regimen. But those who also switched to an integrase inhibitor gained up to twice as much. There is not much data yet about weight gain associated with the experimental longacting integrase inhibitor cabotegravir, which is given by injection every month or two instead of taken as a daily pill. But so far, studies have not reported major weight changes.

Black, and 60% were women. Two years after they started treatment, men gained an average of about 3 pounds on a regimen containing efavirenz plus TDF, 8 pounds on dolutegravir plus TDF and 11 pounds on dolutegravir plus TAF. Among women, the corresponding gains were about 7, 10 and 18 pounds. A smaller subset of participants followed for nearly three years saw continued weight gain, reaching 16 pounds for men and 27 pounds for women taking dolutegravir plus TAF. One in four men and over half of the women taking this combo saw a weight gain of 10% or more, and 8% of the men and 23% of the women met the criteria for obesity. These findings are “a call to arms,” Sara Bares, MD, of the University of Nebraska Medical Center in Omaha, wrote in a recent editorial. “As we continue to investigate the causes, consequences and management of weight gain following [antiretroviral therapy] initiation (and switch), we must strive to enroll sufficient numbers of women from diverse racial and ethnic backgrounds to allow for sex- and race-stratified analyses.”

What Causes Weight Gain? The causes of weight gain among people living with HIV are still not fully understood, but they appear to involve a complex interplay of the effects of the virus and its treatment on immune function, inflammation and metabolism. People with advanced immune suppression and opportunistic illnesses often gain weight as they return to health after starting treatment. HIV infection increases metabolic demands, and stopping viral replication reduces energy expenditure—leading to weight gain if food intake stays the same. Some experts think the seesaw effect as HIV depletes the immune system and antiretrovirals restore immune function may trigger fat gain. Treatment also limits the detrimental effects of HIV on fat cells and prevents opportunistic infections that cause diarrhea, a major cause of weight loss. Plus, people who feel better tend to eat more. But this return-to-health effect does not fully explain treatment-associated weight gain, which occurs even among people who start treatment early and those who switch to newer antiretrovirals with a fully suppressed viral load and a normal CD4 count. One small study found that people starting treatment gained weight despite no changes in appetite, eating habits, calorie consumption or metabolic rate. Newer meds are less likely to cause side effects that lead to weight loss, such as nausea, diarrhea and reduced appetite, but this is also not an adequate explanation. Even with effective treatment, chronic HIV infection triggers ongoing immune activation and inflammation, which promotes fat accumulation. What’s more, the virus damages the gut, leading to changes in the microbiome and leakage of bacteria that spurs inflammation; antiretrovirals may not fully reverse this damage. In a study of people who gained weight after starting treatment, those who had biomarkers indicating a high level of immune activation were more likely to gain weight—an effect that was most pronounced among women. Studying HIV-negative people who take antiretrovirals for pre-exposure prophylaxis (PrEP) can help tease out the return-to-health effect. In the DISCOVER trial, people who

“Weight gain has certainly been a very big issue in the HIV research world for the last two years.”

Who Is at Risk? Not everyone is equally prone to weight gain after starting or switching antiretrovirals. People who start treatment with a lower CD4 T-cell count or higher viral load are more likely to gain weight. In fact, in the eight-trial analysis, a lower pretreatment CD4 count was the strongest risk factor. Older people are more likely to develop lipodystrophy, and some research suggests they are at greater risk for generalized weight gain as well, although study results have been mixed. But even adolescents starting treatment with dolutegravir have experienced unusual weight gain. Perhaps most strikingly, women tend to put on more pounds than men, as do Black people compared with white people—meaning Black women with HIV are particularly susceptible to weight gain. Women and people of color have been underrepresented in HIV research in the United States and Europe. Studies of mostly white men appear to have underestimated the problem of treatment-associated weight gain, highlighting the importance of greater diversity in clinical trials. The ADVANCE trial in South Africa looked at more than 1,000 people starting first-line HIV regimens; most were

WEIGHT GAIN POZ FOCUS 7

switched from TDF/emtricitabine to TAF/emtricitabine for PrEP gained more than 2 pounds on average over a year, while those who stayed on the TDF combo saw no change in weight. Several mechanisms have been proposed to explain why integrase inhibitors, in particular, lead to weight gain. Some studies suggest this class of drugs may damage fat cells, interfere with hormones produced by fat tissue and promote insulin resistance. What’s more, dolutegravir appears to block a receptor for melanocyte-stimulating hormone, which plays a role in regulating appetite. In summary, much remains to be learned, and weight gain will continue to be an active area of HIV research. “I’m concerned that we don’t understand why weight gain is happening,” says Steven Grinspoon, MD, a professor of

medicine at Harvard Medical School and director of the Nutrition Obesity Research Center at Harvard. “Are there genetic predispositions? What is the mechanism of it? Will the weight gain reverse over time? There are many unanswered questions. We also don’t have good data as to whether the fat [linked to] integrase inhibitors is associated with the same types of morbidities as weight gain in general.” “There may be an element of return to health involved, but for some people, it’s much more than that—you can’t tell me that someone who gains 20 or 30 pounds is returning to health,” he adds. “That’s a small minority of patients, but for that minority, it’s important. I think we should study those people that have the most severe weight gain to see if there’s anything special about them.” ■

Managing Weight Gain A healthy diet and exercise are key to controlling excess weight.

8 POZ FOCUS WEIGHT GAIN

spread out over multiple days—as well as musclestrengthening activities. But any amount of physical activity is better than none. “Exercise is important in two ways,” Grinspoon says. “One, it helps reduce weight, and two, it’s anti-inflammatory. It will help your blood pressure and help your glucose. Getting some exercise every day is very helpful.” Unfortunately, it can be difficult to lose weight—and especially to reduce visceral fat buildup—with changes in diet and exercise alone. In some cases, medications may help. Metformin, a drug used to control blood sugar in people with type 2 diabetes, reduces appetite and can lead to weight loss; it also has anti-inflammatory properties. Studies have shown that metformin led to a decline in body weight, reduced visceral fat and improved the health of the gut microbiome in people living with HIV. Tesamorelin, which mimics a natural hormone produced in the brain, is approved to reduce excess belly fat in HIV-positive people with lipodystrophy. The growth hormone analogue somatropin is approved to treat HIV-related wasting, but studies suggest it may also help reduce visceral abdominal fat. Other medications can help manage the metabolic abnormalities that often accompany weight gain. Statins, prescribed to lower cholesterol and reduce the risk for heart attacks and strokes, also have anti-inflammatory properties and may offer a two-for-one benefit for people living with HIV. Grinspoon’s team is currently studying this in a large clinical trial called REPRIEVE. —LH

Tips for Your Overall Health ■

Eat a healthy diet.

■

Get enough exercise.

■

Quit smoking.

■

Limit alcohol and drug use.

■

Get adequate sleep.

■

Find ways to reduce stress. ISTOCK

Let’s start with what you should not do to manage weight gain: delay or stop HIV treatment. The newest antiretrovirals are highly effective, and keeping the virus under control is the most important thing you can do to improve your overall health. “There is never any reason to stop antiretroviral therapy, which is lifesaving and incredibly important,” says Monica Gandhi, MD, MPH, director of Ward 86, the HIV clinic at Zuckerberg San Francisco General Hospital. However, people who are more prone to putting on pounds may consider avoiding meds that are often linked to weight gain. This is now a big enough concern that it’s become one of the many factors to think about when selecting which drugs to use. “It has become such an issue at Ward 86 that we have started to put weight as one of our baseline criteria when we decide on a regimen,” Gandhi says. So far, there hasn’t been much research examining whether switching drugs can reverse generalized weight gain, though changing meds has little effect on visceral fat accumulation in people with lipodystrophy. “We don’t yet know whether switching off of integrase inhibitors or tenofovir alafenamide to alternative drugs will have an effect on weight gain,” says Marshall Glesby, MD, PhD, of Weill Cornell Medical College in New York City. “Changing antiretroviral combinations does not seem to affect lipohypertrophy.” Preventing weight gain is easier than losing weight. People starting antiretrovirals or switching regimens should have their weight, body mass index and waist circumference measured at the outset and monitored regularly to catch unusual changes as soon as possible. Monitoring blood sugar (glucose) and lipids such as cholesterol and triglycerides is also useful. Lifestyle changes can help control weight gain in HIV-positive and HIV-negative people alike. Experts recommend eating a balanced diet rich in plant-based foods and low in unhealthy fats, sugars and processed foods. For example, Steven Grinspoon, MD, director of the Nutrition Obesity Research Center at Harvard, says a Mediterranean diet is a good option. Exercise is also key. Aim to move more and sit less throughout the day. Federal guidelines recommend at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous activity per week—ideally

Body Positive Aging with HIV won’t slow down Robert Gillum.

JENSEN LARSON JAMEY GUY

By Alicia Green When Robert Gillum tested HIV positive in 1987, he was incarcerated and facing 30 to 60 years in prison. He was only 21 years old. “I had a swollen lymph node underneath my chin,” says Gillum, now 54 and living in Virginia. “It was unusual because I touched my body a lot and was very in tune with it.” When Gillum visited a nurse, he wasn’t informed he was being tested for HIV. He had his blood drawn, and two weeks later, he received his diagnosis. As someone who grew up in the Baptist church, Gillum immediately felt comforted by God. He didn’t see himself as a victim and never thought he would die. Gillum spent only five months in jail. After standing trial, he was acquitted of all charges and resumed life as he’d known it. “Nothing had changed for me,” he recalls. “I was still young and immature. I continued to go back into drug addiction and partying.” It wasn’t until he stopped using drugs and started working in the HIV field six years later that he transformed his life. Gillum didn’t start HIV treatment

until 1999, when he began taking a protease inhibitor. He refused an early HIV drug he was offered in 1990—despite his mother suggesting he try it. His reasoning was that people who took it got sick. But he remained healthy during those intervening years. He insisted that his doctors look at his CD4 T-cell count without giving him the number and make suggestions about what he should do regarding treatment. He would then make a decision on whether to begin taking medication. Over the past three years, Gillum has switched between two singletablet regimens. He believes each of them has caused him to gain weight in different ways. “I have gained 20 to 25 pounds,” he says. “I’ve never been anywhere near this big in my life. Pants that I bought a year ago, now I can’t fit in.” His doctor can’t confirm or deny whether his current treatment is responsible for the extra pounds. However, the suspected HIV combo contains an integrease inhibitor and tenofovir alafenamide (TAF), which have both been associated with an increase in weight.

“I know my body,” Gillum says. “I know what it’s doing.” Gillum and his new doctor have discussed changing his treatment again, but she wants to monitor his weight for 90 days to see whether anything happens within that window of time. To lose weight, Gillum does cardio exercises three times a week. He also drinks more water and eats more vegetables and fruits to keep himself healthier overall, especially as someone aging with HIV. “No one was really studying how long you were going to be living with HIV,” he says. “We weren’t worried about the long-term things, but now we are.” Gillum is currently in the process of editing his memoir. He hopes to complete it by his birthday next year so he can use it to do more outreach within the HIV community. “Don’t let HIV define you,” he says. “Live your life. HIV is just another virus. You can live and not allow it to dictate to you what you can be and what you can accomplish. I’ve done a lot of stuff that I never thought would happen when I tested positive in ’87.”

WEIGHT GAIN POZ FOCUS 9

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Double check to verify where and how to vote.

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Early voting, absentee voting and vote-by-mail are options and may have already started.

Election Day is Tuesday, November 3. Vote! Voting is how we shape our democracy. Daunting? Maybe. But now, more than ever, it is important to vote. Plan when you will vote and how you will vote. Then plan to help others vote.

Donâ&#x20AC;&#x2122;t Forget

Visit the Black AIDS Institute for HIV testing and other clinical services A Clinic For Us 4249/4251 Crenshaw Blvd. Los Angeles, California 90008 213-226-7488

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