European AIDS Clinical Society (EACS) guidelines on the prevention and management of metabolic diseases in HIV^*

Abstract

BackgroundMetabolic diseases are frequently observed in HIV-infected persons and, as the risk of contracting these diseases is age-related, their prevalence will increase in the future as a consequence of the benefits of antiretroviral therapy (ART). Summary of guidelinesAll HIV-infected persons should be screened at regular intervals for a history of metabolic disease, dyslipidaemia, diabetes mellitus, hypertension and alteration of body composition; cardiovascular risk and renal function should also be assessed. Efforts to prevent cardiovascular disease will vary in intensity depending on an individual's absolute risk of ischaemic heart disease and should be comprehensive in nature. Lifestyle interventions should focus on counselling to stop smoking, modify diet and take regular exercise. A healthy diet, exercise and maintaining normal body weight tend to reduce dyslipidaemia; if not effective, a change of ART should be considered, followed by use of lipid-lowering medication in high-risk patients. A pre-emptive switch from thymidine analogues is recommended to reduce the risk of development or progression of lipoatrophy. Intraabdominal fat accumulation is best managed by exercise and diet. Prevention and management of type 2 diabetes mellitus and hypertension follow guidelines used in the general population. When using medical interventions to prevent and/or treat metabolic disease(s), impairment of the efficacy of ART should be avoided by considering the possibility of pharmacokinetic interactions and compromised adherence. Specialists in HIV and specialists in metabolic diseases should consult each other, in particular in difficult-to-treat cases. ConclusionMultiple and relatively simple approaches exist to prevent metabolic diseases in HIV-infected persons; priority should be given to patients at high risk of contracting these diseases.

HIV infection, aging and cardiovascular disease: epidemiology and prevention

“…96 The management of hypertension and diet are components of the management and prevention of dyslipidaemia and CVD. 90,92 In the general population, dietary interventions are effective in reducing hypertension. In the HIV setting, one study involving intensive lifestyle intervention, including dietary and physical activity counselling, showed a significant reduction in blood pressure.…”

“…Lipid measures are also to be evaluated before commencing ART, then within 3-6 months of starting a new regimen and then yearly, unless abnormal and therapeutic interventions are commenced. 90,92 Possible drug-drug interactions with ART need to be considered when lipidlowering treatment is initiated.…”

Characteristics of Older Patient with Haemophilia

“…cART has also reduced the previously frequent incidence of non-Hodgkin lymphomas (Ragni, 1993, Wilde, 2002. However, cART increases the risk of the metabolic syndrome, diabetes, renal insufficiency, and atherosclerotic cardiovascular disease in nonhemophilia patients (Lundgren et al, 2008). It is likely to suspect that cART will induce the same long-term complications among HIV-infected elderly patients with hemophilia, although there are very rare data about the long-term outcome of such patient subgroup.…”

Arterial hypertension and dyslipidemia in a HIV-positive patient treated with antiretroviral therapy

“…Le evidenze appena individuate, insieme a una relativa giovane età di insorgenza e quindi a un notevole tempo di esposizione, hanno portato le società internazionali a stendere linee guida specifiche per questa popolazione per la valutazione del rischio cardiovascolare e per l'appropriata terapia delle alterazioni metaboliche [24,25].…”

“…Le ultime linee guida della European AIDS Clinical Society (EACS -ottobre 2011) [24,25] individuano una strategia di screening più aggressiva rispetto alla popolazione generale evidenziando la necessità di valutare l'anamnesi cardiovascolare, la pressione arteriosa, i lipidi plasmatici, il metabolismo glucidico e gli indici di composizione corporea (BMI, circonferenza addominale, rapporto vita/fianchi e presenza di lipodistrofia) alla diagnosi, prima di affrontare una terapia antiretrovirale, a breve distanza da ogni sua modifica e comunque almeno una volta all'anno.…”