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Management of Metabolic Complications Associated With Antiretroviral Therapy for HIV-1 Infection: Recommendations of an International AIDS Society-USA Panel

November 26, 2002

Alterations in glucose and lipid metabolism, lactic acidemia, bone disorders, and abnormal fat distribution have been recognized recently as frequent complications associated with HIV-1 infection and potent antiretroviral therapy, but limited data are available regarding the appropriate management of these disorders.

A 12-member panel representing international expertise in HIV-1 patient care, antiretroviral therapy, and endocrine and metabolic disorders was selected in the spring of 2000 by the International AIDS Society-USA, a not-for-profit physician education organization. Panel members met in closed meetings beginning May 2000, reviewing published results of clinical, epidemiologic, and basic science studies and data and abstracts presented at research conferences, primarily from 1997-2002. The panel also considered studies involving metabolic abnormalities in noninfected persons. Emphasis was placed on results from prospective, randomized, controlled clinical trials when available. The following summarizes the recommendations the panel developed to guide physicians actively involved in HIV care in the management of metabolic complications that occur primarily within the context of potent antiretroviral therapy (PAT). Assessment and Monitoring

"Metabolic complications of PATs have only been recently recognized, and prospective studies to determine the incidence, etiology, risk factors, and most appropriate treatments for these complications are only now under way or being initiated. There remains a pressing need for guidance in managing these complications while definitive data to establish firm recommendations accrue. Extrapolation from preliminary results of ongoing studies and experience garnered from management of similar metabolic abnormalities in patients who do not have HIV-1 infection serve as the basis for many of these recommendations," the authors concluded.

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Excerpted from:
Journal of Acquired Immune Deficiency Syndromes
11.01.02; Vol. 31, No. 3, P. 257-275; Morris Schambelan; Constance A. Benson; Andrew Carr; Judith S. Currier; Michael P. Dubé; John G. Gerber; Steven K. Grinspoon; Carl Grunfeld; Donald P. Kotler; Kathleen Mulligan; William G. Powderly; Michael S. Saag

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