Metabolic complications

The underlying mechanisms causing metabolic complications are not fully understood. It is thought that HIV disease itself, uncontrolled viral replication, co-infection (particularly with hepatitis C), and the use of ARV drugs, among other factors, can result in altered body fat levels, body fat distribution, insulin resistance, and an increased risk of cardiovascular disease.

Until there is a better understanding of these complications (e.g. lipid abnormalities, insulin resistance, diabetes, lipodystrophy, lipoatrophy, lipohypertrophy, lactic acidosis, and hyperlactataemia), general population management guidelines are being used. The BHIVA guidelines review what is known concerning evaluation of risk, prevention, surgical interventions, and pharmacological management.

Lipid abnormalities are seen in many patients with HIV, whether they are on ARV therapy or not. In some cases, switching from a PI-based therapy to an NNRTI regimen or to another PI can help, but there is variability not only between drug classes, but amongst drugs in the same class.

A discussion of individual metabolic complications can be found in A to Z of illnesses.