Clinical evaluation and management of metabolic and morphologic abnormalities associated with human immunodeficiency virus

In recent years, a spectrum of metabolic and morphologic alterations has emerged among patients infected with human immunodeficiency virus (HIV) receiving antiretroviral treatment. Changes observed include insulin resistance, dyslipidemia, abdominal and dorsocervical fat accumulation, and fat depletion in the extremities and in the face. The health consequences of these changes are not well understood but may include increased risk for diabetes, heart disease, and stroke. Therefore, clinicians that treat patients with HIV need current, practical information on management strategies and interventions for patients with manifestations of HIV-associated lipodystrophy. Literature is reviewed on the health consequences of insulin resistance, dyslipidemia, and alterations in body fat distribution in non-HIV populations to gain perspective on how such abnormalities might affect HIV-infected patients. We also suggest treatments and strategies to manage metabolic and morphologic changes in patients with HIV.