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Since the advent of effective antiretroviral therapy, infection with the human immunodeficiency virus has been transformed, in the Western world, to a chronic disease associated with a variety of metabolic complications.This review provides a brief summary of our current understanding of the epidemiology, clinical presentation and therapeutic approaches of what is termed ‘the HIV-associated lipodystrophy syndrome’ and of HIV-associated lipid and glucose metabolic abnormalities. Other metabolic associations including lactic acidosis, HIV-associated bone disease and the effect of the virus on other endocrine pathways are outside the scope of this article.A bibliographic search was performed using Entrez Pubmed®, edition 2.0, by the National Library of Medicine for articles only in the English language using Boolean operators and the terms ‘HIV, HAART, lipodystrophy, lipoatrophy, lipohypertrophy, hyperlipidemia, diabetes and metabolism, cost of illness’. The Program and Abstract Books of the 8th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV (September 24–26, 2006, San Francisco, USA), the 4th International AIDS Society Conference on HIV Pathogenesis (July 22–25, 2007, Sydney, Australia) and the 47th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy (September 17–20, Chicago, USA) were searched for relative abstracts. Previous publications were used to identify further references. Approximately 1400 articles and abstracts were identified of which 104 were selected for review.Specific medications and medication classes increase the lipoatrophy and lipodystrophy risk. A change of treatment strategy might be beneficial in improving adipose tissue deposition. The effects of HIV on metabolism offer new insights into cardiovascular disease pathogenesis.