Considering metabolic issues when initiating HIV therapy.

Patients with HIV infection and their clinicians are increasingly considering the risk of metabolic complications when choosing HIV therapies. Fear of the potential metabolic consequences of antiretroviral agents may lead some to delay HIV therapy and threaten medication adherence once treatment is initiated. Until recently, there has been limited objective study of the relative contributions of specific antiretrovirals and particular combinations of these drugs to dyslipidemia and body fat changes; in lieu of data, unsupported perceptions regarding the links between therapies and these metabolic complications have predominated. Over the past year, a number of comparative clinical trials have clarified the association between exposure to antiretrovirals and lipid and fat disorders and, in some cases, have yielded results that challenge our perceptions regarding the causes of these complications.