Long-Term Metabolic Complications Associated with
Antiretroviral Therapy
ÎÎFasting glucose and lipid levels should be monitored prior to and
within 4-6 weeks after starting antiretroviral therapy (A-III). Patients
with diabetes mellitus should have a hemoglobin A1c level monitored
every 6 months with a goal of less than 7% in accordance with the
American Diabetes Association Guidelines. Patients with abnormal
lipid levels should be managed according to the National Cholesterol
Education Program Guidelines, with special consideration as
discussed for persons with HIV infection.
ÎÎThere is no rationale for ordering lactic acid tests for asymptomatic
patients at any time during HIV care (A-II).
ÎÎInterruption of NRTI therapy is recommended for symptomatic
patients with a venous lactate level of > 5 mmol/L (B-II).
ÎÎBaseline bone densitometry should be obtained in postmenopausal
women age 65 or older and in younger postmenopausal women who
have one or more risk factors for premature bone loss (B-III).
ÎÎRoutine screening for osteoporosis in HIV-infected patients without
other risk factors for premature bone loss is not recommended at this
time based upon available data, but it should be considered in persons
age 50 or older, especially if they have one or more risk factors for
premature bone loss (B-III).
Adherence
ÎÎAll HIV infected patients should be provided timely access to routine
and urgent primary medical care (B-II).
ÎÎHIV care sites should make every effort to provide care in a way that is
linguistically and culturally appropriate and competent (B-II).
ÎÎHIV care sites should utilize a multidisciplinary model but identify
a primary provider to each patient and support the development of
trusting long-term patient-provider relationships (B-II).
ÎÎAll patients should be evaluated for depression and substance
abuse, and, if present, a management plan that addresses these
problems should be developed and implemented in collaboration with
appropriate providers (B-II).
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