Because there is no cross‐immunity with other coronaviruses, and barriers to virus dissemination have not been optimal at the beginning of the viral spread, the pandemic has rapidly overflowed health systems.

The SARS‐CoV2 infection responsible for Covid‐19 has hit the world mostly unprepared for a massive pandemic due to a new coronavirus with widely diverse clinical phenotypes, ranging from completely asymptomatic expression to septic shock with rapid death. Infectious Diseases and Tropical Medicine Department, Saint‐Antoine Hospital, and Sorbonne University Medical School, Paris, France Answers will only come from well‐designed randomised trials that keep in mind lessons learned from the evaluation of other HIV‐related comorbidities, in particular HIV lipodystrophy.ĬOVID‐19: Where Are We Now and What Next? Multiple unknowns remain, including preventative and treatment strategies, reversibility, outcomes beyond two years of antiretroviral therapy and whether three (rather than one) antiretroviral drug classes can all affect body weight. There are minimal data on any underlying mechanism(s) possibilities include increased appetite, reduce physical activity, or greater ability of adipose tissue to store lipid. The weight gain appears to be modest for most patients, but outliers exist, with weight gain more likely in women and in those of Black race. Some weight gain in adults initiating antiretroviral therapy is due to a ‘return‐to‐health’ or a ‘return‐to‐societal norm’, with substantially less weight gain in patients switching antiretroviral therapy or initiating HIV pre‐exposure prophylaxis. The existing data suggest that some, if not all, integrase inhibitors are associated with weight gain, as is tenofovir alafenamide, whereas tenofovir disoproxil fumarate and efavirenz may inhibit weight gain. This presentation will summarise some basic epidemiology of obesity, and focus predominantly on its relationship to antiretroviral therapy. Weight gain has been noted in more HIV‐infected adults over the last three years. Obesity/overweight is common in the general population and results in an increased risk of death and multiple morbidities.

HIV, Immunology and Infectious Diseases Unit and Centre for Applied Medical Research, St Vincent's Hospital, and University of New South Wales, Sydney, Australia

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