IAS panel issues first guidelines for HIV and HIV drug-related metabolic complications (2002)

The first comprehensive recommendations for assessing, monitoring and treating metabolic complications such as insulin resistance and abnormal body fat distribution that are occurring in association with HIV infection and antiretroviral therapy have been issued by an International AIDS Society-USA (IAS-USA) volunteer panel.

“These recommendations are important for clinicians because significant metabolic complications are affecting as many as half of all HIV-infected patients on antiretroviral regimens. Concerns about complications are causing some patients to delay initiating therapy and others to reconsider their use of these life-saving medications,” said the panel’s chair, Morris Schambelan MD, University of California San Francisco professor of medicine and director of the General Clinical Research Centre at San Francisco General Hospital Medical Center.

The recommendations, published in the 4 November issue of the Journal of Acquired Immune Deficiency Syndromes, identify five major areas of concern:

These metabolic complications are troubling. High cholesterol and blood glucose levels may increase the risk of heart disease and strokes. Lactic acidosis is a potentially fatal disorder.

In the article, the IAS-USA panel makes recommendations to clinicians regarding tests to identify and monitor metabolic complications in HIV-infected patients on antiretroviral therapy in each of the five areas. Approaches such as switching antiretroviral therapy, treatment of the complication with medication and behaviour change such as diet and exercise are evaluated and recommended for each complication.

“Like the first guidelines for antiretroviral use issued by the IAS-USA in 1996 and updated thereafter, these recommendations are a work in progress and may change as new data become available. They represent what is reasonable to do in a clinical practice based on the currently available evidence,” said Schambelan.

Estimated percentages of patients experiencing each complication and possible causes are also discussed in the article. “We are not completely sure about what role HIV-infection plays and what role the antiretrovirals play in each instance. For example, AIDS-related wasting was the first metabolic problem seen in HIV-infected patients and that was clearly associated with HIV infection itself. For the current metabolic complications, antiretroviral medications as well as host factors appear to also play a role,” said Schambelan.

To develop the recommendations, IAS-USA selected a 12-member international panel of experts in HIV clinical care, antiretroviral therapy, and endocrine and metabolic disorders in 2000. The panel reviewed results of clinical, epidemiological, and basic science studies and data, including studies of similar abnormalities in non-HIV infected persons. For each metabolic complication, the panel reviewed all available evidence. The recommendations of the panel were determined by full group consensus.

The guidelines are published in the November 4, 2002 issue of Journal of Acquired Immune Deficiency Syndromes (JAIDS) 2002; 31(3): 257-275. For non subscribers, the full article is available in PDF format on the JAIDS web site for a $20 access charge. Following lobbying by AIDS community organisations and individuals in the US, the full guidelines are now also available free of charge at