Background:The advent of HAART has markedly reduced mortality and morbidity in HIV. Further reduction will result from applying the findings of the START Study to universal use of HAART, but a greater reduction of mortality & morbidity is likely to result from the management of metabolic/cardiovascular (CV) risk in people with HIV infection. The Challenge: We need to better characterise the key metabolic/CV risks for people with HIV, and manage appropriately. The risks include increased CVR due to HIV itself, individual antiretroviral drugs (ARVs), also risks due to delaying or stopping HAART. There is a marked increase in diabetes in HIV compared to age-matched HIV uninfected, which is increasing over time; in our London Hospital cohort in 2015, 15% of our patients have T2DM (7% in 2005) cf to 6% in general population. There is also greater risk of lipodystrophy, features of metabolic syndrome, and also fragility fractures. These issues are likely to accelerate as our cohorts age. The way forward is to promote good quality studies on metabolic/CV risks in HIV, to educate patients and physicians on the current known risks and to calculate these risks so that management can be given. Lifestyle interventions have variable uptake and adherence but all patients should have access to dietary and exercise advice and smoking cessation support, and where appropriate interventions that might include adjustment to the HAART combination, lipid lowering agents, such as statins, vitamin D and bisphosphonates. It is important that the benefits of managing metabolic/CV issues in people with HIV are available to all individuals in the developing and developed world alike.
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