The Western Cape Provincial Department of Health provides nutritional support to underweight (BMI<18.5) HIV patients on ART. Initial evaluation suggested that patients starting ART are more often overweight than underweight. ART may worsen obesity related health conditions, such as heart disease. In turn, obesity may increase side‐effects of ART.ObjectiveTo determine the BMI distribution of patients presenting for ART, and weight change with 3 months of ART, in Mitchells Plain Community Health Center.MethodA retrospective medical record review of HIV patients ages 18–65 initiating ART between August 1‐Oct 31, 2008 (n=117, 63% female, 37% male).ResultsPrevalence of underweight (BMI<18.5) was 12.0%, while 32.5% were overweight (BMI>25). The prevalence of overweight was significantly higher among females than males (42% vs. 16%, p=0.016). Three‐months after initiation of ART, 62% had weight gain with a mean gain of 5.37 kg. Significantly more men gained weight than women (87% vs. 48%, p=0.003). Prevalence of overweight increased to 45% after 3 months of ART with a significant increase in mean BMI from 23.2 to 24.1 (p<0.01). Prevalence of underweight decreased to 2.4%. Of patients with BMI >25, 44.2% were on an ART regime contraindicated with high BMI.ConclusionIn peri‐urban African settings overweight/obesity may be an emerging issue for HIV patients on ART. Source of Funding: Downs Fellowship