I-104 Metabolic and cardiovascular co-morbiditiesin people living with HIV

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Effective antiretroviral therapy has resulted in a marked reduction of HIV associated opportunistic disease but has revealed an increased propensity of people living with HIV (PLWH) to suffer from non-AIDS conditions. A large proportion of these conditions are those associated with aging, including cardiovascular disease, diabetes, and osteoporosis. Type 2 diabetes, as an example, is growing in incidence worldwide due to increased longevity and changes in modifiable risk factors, such as diet. HIV might add a further layer of risk, and we have found estimates of prevalence of T2D in HIV that vary from between 2.6% and 14%. This range is likely to reflect the populations and groups studied, and differences in their traditional risk factors for T2D, as well as additional risk factors for T2D, including duration of HIV infection, degree of immunosuppression, and exposure to those ARVs known to be associated with insulin resistance. Similarly, reduced bone mineral density and increased incidence of osteoporosis and the increased incidence of cardiovascular disease are associated with certain ARTs and with HIV itself. PLWH with T2D have poorer reported outcomes and hence early identification of pre-diabetes will enable preventative measures to be introduced, and will mitigate against the need to manage T2D subsequently. The increased incidence of these co-morbidities requires appropriate research into the aetiology, associations and management of these conditions in order to reduce future morbidity in people living with HIV infection.

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