HIV and the Athlete: Effects of Chronic HIV Infection and Antiretroviral Therapy on Physical Performance and Exercise Capacity

Abstract

Background. Effective antiretroviral therapy (ART) has transformed HIV infection into a chronic condition compatible with long-term physical activity and sport. Nevertheless, chronic HIV infection, ART exposure, comorbidities, and changes in body composition may influence exercise capacity and physical performance.

Aim. To critically review evidence on the effects of chronic HIV infection and ART on cardiorespiratory fitness, muscular function, mitochondrial physiology, body composition, fatigue, and exercise responses, with emphasis on implications for competitive athletes.

Material and methods. This narrative review synthesizes evidence from HIV treatment guidelines, sports-medicine consensus statements, systematic reviews, meta-analyses, randomized controlled trials, observational studies, and selected mechanistic investigations. Earlier findings were interpreted in the context of historical ART regimens.

Results. People living with HIV (PLWH) may demonstrate lower aerobic capacity, muscular strength, and functional performance than HIV-negative populations, although findings are heterogeneous and based mainly on clinical cohorts. Historical ART was associated with mitochondrial and metabolic toxicity, whereas contemporary regimens have a different pharmacological profile. Exercise can improve physical capacity without evidence of adverse effects on virological control.

Conclusions. HIV status alone should not generally contraindicate sport participation in clinically stable individuals. However, athlete-specific evidence remains limited, particularly regarding high training volumes, repeated maximal exercise, recovery, overreaching, and long-term competitive performance with contemporary ART.