The first comprehensive recommendations for assessing, monitoring and treating metabolic complications such as insulin resistance and abnormal body fat distribution that are occurring in association with HIV infection and antiretroviral therapy have been issued by an International AIDS Society-USA (IAS-USA) volunteer panel.

"These recommendations are important for clinicians because significant metabolic complications are affecting as many as half of all HIV-infected patients on antiretroviral regimens. Concerns about complications are causing some patients to delay initiating therapy and others to reconsider their use of these life-saving medications," said the panel's chair, Morris Schambelan, MD, UCSF professor of medicine and director of the General Clinical Research Center at San Francisco General Hospital Medical Center.

The recommendations, published in the November 4 issue of the Journal of Acquired Immune Deficiency Syndromes, identify five major areas of concern: insulin resistance with alterations in glucose metabolism, abnormalities in lipid metabolism, lactic acid disorders, bone disease, and abnormal body fat distribution. These metabolic complications are troubling--high cholesterol and blood glucose levels may increase the risk of heart disease and stroke. Lactic acidosis is a potentially fatal disorder.

In the article, the IAS-USA panel makes recommendations to clinicians regarding tests to identify and monitor metabolic complications in HIV-infected patients on antiretroviral therapy in each of the five areas. Approaches such as switching antiretroviral therapy, treatment of the complication with medication and behavior change such as diet and exercise are evaluated and recommended for each complication.

"Like the first guidelines for antiretroviral use issued by the IAS-USA in 1996 and updated thereafter, these recommendations are a work in progress and may change as new data become available. They represent wha
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Contact: Jeff Sheehy
jsheehy@psg.ucsf.edu
415-597-8165
University of California - San Francisco
4-Nov-2002

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