13
IV. METABOLIC AND OTHER NONCOMMUNICABLE
COMORBIDITIES ASSOCIATED WITH HIV,
ANTIRETROVIRAL THERAPY, AND AGING
77. Lipid levels should be obtained prior to, and within 1–3 months
after starting, ART. Patients with abnormal lipid levels should be
managed according to the National Lipid Association Part 2 and
2018 Multispecialty Blood Cholesterol Guidelines.
78. Random or fasting blood glucose (FBG) and hemoglobin A1c
(HbA1c) should be obtained prior to starting ART. If random glucose
is abnormal, fasting glucose should be obtained. After initiation
of ART, only plasma glucose criteria should be used to diagnose
diabetes. Patients with diabetes mellitus should have an HbA1c
level monitored every 6 months with an HbA1c goal of <7%, in
accordance with the American Diabetes Association Guidelines.
79. Baseline bone densitometry (DXA) screening for osteoporosis should
be performed in postmenopausal women and men aged ≥50 years.
There is insufficient evidence to guide recommendations for bone
density testing in transgender or nonbinary individuals. Screening
for transgender people should follow national recommendations
based upon their sex at birth and individualized based on risk for
osteoporosis.
80. Testosterone replacement therapy for cisgender men should
be prescribed with caution and only in those with symptomatic
hypogonadism, given the long-term side consequences. (See Section
VIII for discussion of hormone therapy for transgender men)
