4688-NIA HIV & Metabolic Disorders Cover-v3ƒ 11/7/07 10:30 AM Page 1

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Lipid Abnor

Body Fat Compl

Keep Your Heart 

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Resources and Additional Info

Frequently Asked Questio

Glossary (Definition 
Introduction 
Intro
(HIV) and are at risk for developing metabolic complicatio

lead to heart disease. We have included a definition of ter

glossary, in the back of this book to help you become more 

all of the medical words that you will come across. The term

included in the glossary will appear in bold the first time th

the book. 

You will learn about metabolic complications, which are illn

diabetes, hyperlipidemia, and lipodystrophy. These illne

do with your blood sugar or how you process and store fats 

Specifically, you will learn about: 

• How these conditions relate to heart disease 

• What you can do to lower your risk of developing metab

complications and heart disease 

• Testing and treatment options for metabolic complications 

• How metabolic complications may influence your antiretro

While this book provides helpful information, it may not ans

your questions about the metabolic complications of HIV tre

should visit your doctor regularly and talk with others on yo

team (nurse, case manager, outreach worker) about treatme

your needs change and as new research uncovers other trea

options. In addition, there are many groups, hotlines, Web 

other helpful resources that you can use to learn more abou

complications – often at low or no cost. Please see Resource

Additional Information, beginning on page 29, for a more co
However, drug reactions associated with long-term use of HAAR

metabolic complications such as: 

• Lipid abnormalities such as hyperlipidemia (too much fat in yo

• Lipodystrophy (abnormal body fat distribution) 

• Hyperglycemia 

• Diabetes 

• Lactic acidosis 

• Decreased bone mineral density 

The long-term impact of these complications is unknown, but they 

your daily life and pose a threat to your cardiovascular health. W

metabolic complications of HAART have been shown to increase 

of developing heart disease, this risk is considerably less than th

heart disease associated with smoking, for example. Studies hav

shown that the benefits of HAART far outweigh the risks – and th

steps you can take to decrease any potential metabolic complica

This book will focus on metabolic complications of HAART involv

diabetes, lipids, and body fat as they relate to cardiovascular d

We will explain each potential complication and provide you w

information so that you can talk to your health care provider an

steps that could benefit the health of your heart. 

Why is a healthy heart so important? 

Heart disease is the number one cause of death and disability i

United States and most European countries. By the time heart pr

are detected, the underlying cause is usually quite advanced, ha

progressed for decades. That’s why it’s important to prevent hea

disease with healthy lifestyle choices, such as healthy eating, ex

and not smoking. 

4 
refer to those related to atherosclerosis (arterial disease)  a 

the arteries. It is dangerous because it can lead to heart atta

Cardiovascular disease is usually treated by doctors known 

cardiologists, thoracic surgeons, vascular surgeons, neurolog

interventional radiologists, depending on the part of the body 

In addition to the possibility of HAART contributing to the ris

disease, there are risk factors that may make it more likely f

develop heart disease: 

RISK FACTOR RESULT 

Age Your risk for heart disease increases as you ge

Diabetes If you have diabetes, you are at a greater risk 

Exercise If you do not exercise, you are at a greater ris

heart disease 

Gender Normally, men under the age of 64 are more 

serious heart disease than are women; howeve

declines as you get older and heart disease is 

health problem for women as well as men in indu

Genetics If you have a family history* of heart disease, 

greater risk for developing it too 

High blood pressure The higher your blood pressure, the harder yo

work to pump your blood 

High cholesterol and 

abnormal lipid profiles 

Increased cholesterol in your blood can build u

arteries, leaving less space for your blood to p

Obesity The higher the amount of unhealthy weight you

carry, the harder your heart has to work 

Smoking Smoking increases blood pressure, decreases 

you are able to exercise, and increases the ten

to clot (which makes it more difficult for it to flo

Stress and depression Stress may affect your blood pressure and cho

and when you are stressed you may be more 

exercise less, and overeat 

* “Family history” is defined as any members of your immediate family (mother, fath

brothers) having developed coronary heart disease (angina or heart attack) at a yo

(females under 65 and males under 55). 
risk of developing heart disease. 

• Maintaining a healthy, low-fat diet, and exercising for just 30 

a day most days of the week are simple lifestyle changes you 

to improve your cholesterol levels and increase the health of yo

• Studies have shown that keeping your total cholesterol under 

a powerful way to decrease your risk of developing heart dis

-

Some risk factors cannot be changed, such as 

your family history, age, and gender. But here are 

some positive changes you may be able to make: 

• Quit smoking. It’s one of the most effective ways 

to decrease your risk of developing heart disease. 

• Maintain a healthy, low fat diet, and exercise for ju

30 minutes a day most days of the week. These sim

lifestyle changes can improve your cholesterol level

and increase the health of your heart. 

• Keep your total cholesterol under 150. This 

is a powerful way to decrease your risk of 

developing heart disease. 

6 
Diabetes 
Diabetes 
of your internal organs called the pancreas. Insulin signals t

take up and store glucose as energy. When you have diab

builds up in your blood stream and, if left untreated, this glu

damage your heart, kidneys, nerves, and eyes. High blood 

hyperglycemia, may be one of the first warning signs that y

developing diabetes. 

There are two main forms of diabetes – type 1 and type 2. 

diabetes is usually found in children and young adults and 

autoimmune disease that causes the body’s immune system 

the insulin-producing cells in your pancreas. Type 2 diabete

more common and is usually diagnosed in adults over the a

However, because childhood obesity is increasing, more ch

being diagnosed with type 2 diabetes. If you have type 2 d

body may be able to produce the right amount of insulin, b

effectively. Eventually, your body may stop being able to pro

right amount of insulin and your blood sugar will become h

Studies have shown that HIV-infected patients taking HAART 

risk for type 2 diabetes. Antiretroviral medications may inte

body’s ability to store and/or process blood sugar and are 

with the development of insulin resistance. If you are also infe

hepatitis C, then the risk of developing type 2 diabetes is gr

have a family history of diabetes, this also places you at ris

type 2 diabetes can be treated with diet, exercise, and med

However, if it is not treated, it can lead to more serious com

such as heart disease. 
because the glucose is not being converted into energy) 

• Increased urination (because the body is trying to get rid of e

glucose in the urine) 

• Unexplained weight loss or gain 

• Tingling or numbness in hands and feet (this can be caused b

nerve damage) 

The complications of diabetes can include: 

• Decreased or loss of vision 

• Kidney disease 

• Poor wound healing 

• Decreased sensation and blood flow in the extremities 

• Heart and blood vessel disease 

• Stroke 

If you have any of these symptoms – or if you are overweight or 

family history of type 2 diabetes – you should talk to your docto

being tested for diabetes before starting any new HIV medicatio

Doctors can diagnose type 2 diabetes after listening to you desc

symptoms, conducting a physical examination, and performing 

as a blood glucose test, an Oral Glucose Tolerance Test (OGTT)

random urine tests. Your doctor also may perform a liver functio

which can assess the presence of liver damage – a possible fac

related diabetes. 

8 
plasma glucose test, but your doctor also may take random 

your plasma. If you are getting a fasting plasma glucose tes

be able to eat for 8 hours before your test. If your fasting gl

greater than 126 mg/dl or your random glucose levels are 

200 mg/dl, this is consistent with a diagnosis of type 2 dia

Oral Glucose Tolerance Test (OGTT) 

This is a test to see how well your body can process sugar. 

asked to go to your doctor’s office after 8 hours of fasting a

something sweet to drink. Your blood glucose level is checke

drink and then 1 to 3 hours after the drink. The test typically 

hours. If your blood glucose is over 200 mg/dl at 2 hours, 

consistent with a diagnosis of type 2 diabetes. 

Random urine test 

This test checks to see if glucose, protein, and ketones are in 

This is a simple test in which your doctor will put a “dipstick

of your urine. If glucose, protein, or ketones are present, the 

indicator strip will change color. If the strip does change co

may need to have further tests done to see if you may have 

What can I do? 

In many cases, type 2 diabetes can be controlled by simple 

changes including diet and exercise. A healthy diet – low in 

fat, sugar, and salt; high in fiber, vegetables, and fruit – is v

in managing type 2 diabetes. Carbohydrates should be sp

throughout the day to prevent high blood sugar levels after 

exercising just half an hour most days of the week can help 

use insulin more effectively. 
If you feel you are at risk for developing diabetes, you should talk 

doctor or health care provider about possible testing. 

Q: Question

to Ask Your Docto

• Does my HAART put me at risk for developing
 

type 2 diabetes?
 

• Does my family history put me at risk for developing 

type 2 diabetes? 

• Do I have any other risk factors for developing
 

type 2 diabetes?
 

• What steps can I take in my daily life to decrease 

my risk of developing type 2 diabetes? 

• When should I have a test for diabetes? 

10 
Lipid Abnormalities 
Lipid Abnormalities 
and triglycerides, in your blood. If untreated, this increase 

lead to heart disease and pancreatitis. Studies have shown 

protease inhibitors (PIs) such as ritonavir, lopinavir, and ne

raise blood lipid (fat) levels, having a negative effect on trig

total cholesterol, and low-density lipoprotein (LDL) choles

Also, efavirenz, a non-protease inhibitor drug, has been sho

certain blood lipid levels. Remember, the benefits of HAART 

shown to greatly outweigh the risks, but you still need to be 

health of your heart. 

Factors that can increase your risk of developing hyperlipide

• Alcohol use 

• Family history 

• Diabetes 

• A high-fat, high-carbohydrate diet 

• Lack of exercise 

• Hypertension (high blood pressure) 

• Hypothyroidism 

• Obesity 

• Smoking 

Unlike diabetes, hyperlipidemia has no symptoms. The only 

doctor will know if you develop hyperlipidemia is through la

tests. When you begin HAART, your doctor should conduct 

profile to determine your baseline lipid levels. Your doctor 

monitor your lipid levels at least once a year or after any ch

your HAART regimen. 
For example, you could: 

• Switch to or maintain a low-fat diet (particularly low in satura

to control your weight; low-fat diets have more fresh fruits, veg

and whole grains and less animal fat, butter, margarine, may

and fried foods, for example 

• Begin an exercise routine – exercising just 30 minutes most d

the week can greatly increase the health of your heart 

• Quit smoking and limit how much alcohol you drink1 

If lifestyle changes are not enough, you and your doctor may de

use medication to lower your cholesterol and triglyceride levels. 

common medications for treating high cholesterol are a group o

called “statins.” The statins form a class of hypolipidemic agen

lower cholesterol levels in people who have or are at risk for de

heart disease. Because there is a risk of drug interaction betwee

and your HAART, your doctor will help you choose the medicati

works best with your HIV treatment. 

Triglyceride levels can often be improved with dietary changes a

However, many patients who have high levels of triglycerides w

to take medication. If you have high triglyceride levels without h

cholesterol, your doctor may recommend taking medication calle

acid derivation. Fibric acid derivatives, or fibrates, work by red

production of triglycerides and increasing high-density lipoprot

cholesterol (the good cholesterol). They also reduce LDL levels (th

cholesterol). If you experience high triglycerides and high cholest

doctor may recommend taking a statin or fibrate. Again, your d

know the best medication for you based on your HIV treatment. 

1 Refer to the “Resources and Additional Information” section, beginning on pag

to identify help and support groups in your area. 

12 
Talk with your health care team 

A healthy heart can make you feel better, reduce your need 

emergency treatment, save you money, and help give you p

mind. A good first step would be to talk with your doctor or 

provider about hyperlipidemia. Ask about your baseline lipi

tell your doctor that you would like to make healthy lifestyle 

decrease the possibility of developing heart disease. 

Q: Question

to Ask Your Doc

• Do I have high levels of cholesterol or triglycerides

• What lifestyle changes should I make to maintain a 

healthy heart? 

• Can you recommend a dietician that will speak wit

about a heart-healthy diet? 

• Can you recommend an exercise program that is ri

for me? 

• Can you recommend a smoking cessation program 

is right for me? 

• Would you explain the possible impact of my HAAR

medications on the health of my heart? 
this book or undergoing your treatments. Be sure to take this bo

you to your medical appointments to get answers to these quest

14 
Body Fat 

Complications 
Body Fat 
disturbance in the way your body produces, uses, and store

either lose fat from particular areas of your body – called lip

accumulate fat in certain areas – called increased adiposity. S

that lipodystrophy is associated with taking antiretroviral me

The most common areas where fat is lost are: 

• Face – your cheeks, temples, and eyes may appear sunke

• Arms and legs – your veins may become more visible; thi

called “roping” 

• Buttocks 

The most common areas where fat accumulates are: 

• The back of your neck and your upper shoulders – often d

“buffalo hump” 

• Abdomen – also called “protease paunch” or “Crixivan p

• Breasts – in both men and women 

• Different parts of your body may develop fatty growths ca

In addition to taking NRTIs and PIs at the same time, there a

other risk factors for developing lipodystrophy. They include

• Age – older people are at a higher risk 

• Race – Whites have the highest risk 

• Gender – men are more likely to experience fat loss in th

legs, while women tend to have an increase in abdominal 

• Length and severity of HIV infection – the longer and mor

HIV infection, the higher your risk 
Tests for lipodystrophy 

Unlike the symptoms of diabetes and hyperlipidemia, you and y

doctor will be able to see the signs of lipodystrophy. Usually, yo

will diagnose lipodystrophy by examining your body for change

distribution. Your doctor may measure around your arms, thighs

hips, and neck before you begin your HAART and monitor any 

throughout the course of your treatment. Computed tomograph

scanning and magnetic resonance imaging (MRI) are genera

considered the most accurate tests for abnormalities in body fat. 

scanning is a medical imaging method that uses two-dimensiona

to generate a three-dimensional image inside a certain area of t

An MRI produces computerized images inside your body tissue 

causing the atoms within your body to “stand up and dance” to 

radio wave frequency. However, neither test is practical for rout

monitoring because they are expensive, but they continue to be 

tools for studying lipodystrophy. 

Other possible tests for measuring body fat include bioelectrica

impedance analysis (BIA), dual energy x-ray absorptiometr

(DEXA) scans, and anthropometric measurements. The use of 

anthropometric measurement (girth and skinfold thickness) is a q

easy, and inexpensive way to estimate body composition. For ex

using a standard measuring tape, girth and length measurement

taken from specific points on the body. Your health care provide

follow these measurements over time. 

What can I do? 

Unfortunately, there are no simple lifestyle changes to completely 

counteract the effects of lipodystrophy on your body. However, a 

16 
its effects: 

• The severity of the lipodystrophy 

• How much you are bothered by the changes in your body 

• How strongly you want to reverse the effects 

• If you are uncomfortable with the way your body looks a

that it may “broadcast” your HIV diagnosis 

Talk with your health care team 

If you have visible signs of lipodystrophy, you may feel that 

of life has decreased. If you are self-conscious about the cha

body or if you have questions or concerns, you should spea

doctor or health care provider about lipodystrophy. 

Q: Questio

to Ask Your Doc

• Can changing my antiretroviral therapy help reve

lipodystrophy? 

• What are my risks of developing lipodystrophy? 

• If I develop lipodystrophy, what are your 

recommendations for treatment? 

• How does lipodystrophy impact my overall health
18 
Keep Your 

Heart Healthy 
Keep Your Heart Healthy 
changes you can make to help ensure a healthier heart. The 

important things you can do for your heart are to maintain a 

diet, exercise regularly, and avoid smoking. 

Maintain a healthy diet 

The American Heart Association recommends eating a varie

nutritious foods from all of the food groups. You should eat 

calorie, nutrient-rich foods that contain vitamins, minerals, a

less nutrient-poor foods that may fill you up without providin

benefits. Smart, healthy choices include vegetables, fruits, w

foods, and low-fat dairy products. Fresh fruits and vegetable

in vitamins, minerals, and fiber – and they are low in calori

Eating fruits and vegetables can help control your weight, y

pressure, and your cholesterol. Whole-grain foods are high 

also can help control your cholesterol. They also can make y

which may help you control your weight. Also, studies have 

eating fish twice a week – oily fish containing omega-3 fat

as salmon and trout – may help lower your risk of coronary a

In addition to eating foods high in vitamins, minerals, and fib

limit the foods you eat that are high in saturated fat, trans fa

and sodium. Be sure to read food labels carefully – the nutr

information listed on the package can help you make health
• Select low-fat dairy products such as skim milk or 1% milk, low

cream, and low-fat cottage cheese. 

• Reduce trans fat in your diet by cutting back on food such as 

bought cookies, cakes, crackers, and snack foods containing 

hydrogenated vegetable oils. Check the ingredients for the wo

"partially hydrogenated" or "shortening" and avoid these foo

• Cut back on foods that are high in cholesterol. Foods from an

(especially egg yolks, meat, poultry, fish, seafood and whole-

products) have cholesterol. Foods from plants (fruits, vegetable

grains, nuts and seeds) don't. 

• Cut back on beverages and foods with added sugars, such a

soft drinks, fruit juice, energy drinks, candy, cakes, cookies, a

Try to avoid foods containing high fructose corn syrup. 

• Choose and prepare foods with little or no salt. Your grocery 

probably has a salt substitute that tastes very much like the re

• If you drink alcohol, drink in moderation – that means one dr

day for women and two drinks per day for men. 

Get moving 

Most of us lead very busy lives and often 

do not make time to exercise regularly. 

However, exercising just 30 minutes a day 

most days of the week is an extremely 

important step to take for the health of your 

heart. You don’t have to use expensive 

equipment or go to a gym to get the daily 

exercise you need – you can incorporate 

physical activity into your daily life at 

home, at the office, and at play. 

20 
 Work in the garden or mow the grass 

with a push mower 

• Go for a walk before breakfast and 

after dinner – you can start slow with 

a 10-minute walk and work up to a 

30-minute walk 

• Walk or bike to the store instead 

of driving 

• Increase your normal walking pace from leisurely to brisk 

• Stand up and walk around while talking on the telephone 

• Walk your dog 

• Park farther away when going to the store 

• Wear your sneakers to the mall and do a few extra laps w

If you work sitting down most of the day, there are still thing

during the workday to increase your physical activity. 

You can: 

• Brainstorm projects and ideas while taking a walk with co

• Stand up while talking on the phone 

• Walk to someone’s office to speak with them instead of c

on the phone 

• Take the stairs instead of the elevator 

• Stay at locations with fitness centers 

if you travel for work 
• Take walks during your lunch break – 

schedule and treat them like any other 

important appointments 

• Get off the bus or subway a few stops 

early and walk the rest of the way 

• Park farther away from work 

Exercise can be fun. You can get in shape while having a good 

For example: 

• Take family trips that include physical activities 

such as hiking or skiing 

• See new cities by walking or bicycling 

• Set a date with a friend to enjoy activities such as tennis, 

swimming, or dancing 

• Listen to your favorite music 

while exercising 

• Take dancing lessons 

• Join a recreational club 

• Go bowling instead of to the movies 

• Bike to your friend’s house instead 

of driving 

22 
the leading preventable cause of disease and deaths in the 

States.” Cigarette smoking is the single most important risk f

heart disease in youn

women. When paire

How much risk factors, it greatly 

your overall risk. Sm

can you save cigarettes can increa

blood pressure, decr

if you don’t tolerance for exercise

the tendency for you

buy cigarettes clot, and decrease y

(good) cholesterol. A

every day? these factors increase 

developing heart dis

Even if you have been smoking 

for a long time, your risk of developing heart disease decre

as you quit. Over time, it will be like you never smoked at a

quitting will be tough, it is a very important step for you to t

your heart. Luckily, there are many resources 

available to help you quit smoking. 

You should talk with your doctor to help 

make a “quit plan” or to find out about 

medications proven to be useful in 

helping people to quit smoking. 
• List the reasons why you
 

should quit and read
 

them several times a day


• Wrap your cigarette pack with
 

paper and rubber bands; each time
 

you smoke, write down the time
 

of day, how you feel, and how
 

important that cigarette is to you
 

on a scale of one to five


STEP	 STEP 

• Keep reading your • Do not buy 

list of reasons to quit a new pack unt

and add to it	 you’ve finished 

the one you ar

• Do not carry matches currently smoki

or a lighter and keep 

your cigarettes • Change brands 

out of easy reach	 during the wee

decreasing the am

• Try to smoke fewer of tar each time 

cigarettes each day 

and try not to smoke • Try to stop fo

the ones that are	 48 hours in a row 

not important STEP 

• Stop smoking
 

completely


• Get rid of all your smoking-related
 

items such as ashtrays and lighters
 

• Avoid situations that will
 

cause you to want to smoke
 

• Use healthy substitutes for
 

cigarettes such as sugar-free gum,
 

or carrot and celery sticks
 

• Do deep breathing exercises
 

when you get the
 

urge to smoke
 

24 
Next Steps 
Next Steps 
as healthy as possible? 

Know your risk for heart disease 

Your HAART therapy may increase your risk for heart diseas

a good idea to know about all of your major risk factors. Som

can’t be changed, while others can be modified, treated, or 

Major risk factors that can't be changed 

• Increasing age 

• Male sex (gender) 

• Heredity (including race) 

Major risk factors you can modify, treat, or control 

by changing your lifestyle or taking medicine 

• Tobacco smoke 

• High cholesterol 

• High blood pressure 

• Physical inactivity 

• Obesity and overweight 

• Diabetes 

Other factors that may contribute to heart disease ris

• Stress 

• Alcohol 

Source: American Heart Association 
take a closer look at all of your risk factors for heart disease. 

Your screening assessment should include: 

• Family history 

• Smoking status 

• Diet 

• Level of alcohol intake 

• Level of physical activity 

• Blood pressure 

• Weight 

• Waist circumference 

• Pulse 

• Cholesterol 

• Blood glucose (sugar) 

Be sure to keep in touch with your health care team 

Your health care team knows what strategies will work best with 

HAART and your body. If you have any questions or concerns a

health and the health of your heart, speak with your health care 

directly. Your team is there for you, so don’t be afraid to ask for 

up to you to take control of your health. 

It’s important to keep taking your HAART medication—don’t stop ta

medication without talking with your doctor or health care provi

26 
and warnings 

• Your side effects disappear—or if a symptom changes or 

• Your use of alcohol or other non-prescribed drugs increas

• You are planning to change your diet 

• You are planning to begin an exercise program 

• You are planning to quit smoking 

Consider joining a clinical trial 

In addition to answering your questions, your providers also 

access to valuable resources such as clinical trial informatio

latest health information. 

All drugs that are currently available have been studied in c

because that’s the only way to find out if a drug works well

trials are studies that look at how well the drug is going to w

people like you. Clinical trials give you the chance to receiv

potentially effective medical treatments. They don’t cost you 

and still involve visits to your regular doctor. If you develop 

complications from your HAART, you may be eligible for a c

There are a number of clinical trials currently under way and 

specialists in different fields work together on these studies. 

should discuss this option with your doctor to see if you are 

to participate in any ongoing studies in the treatment of you

For more information on clinical trials, see the Resources an

Information section beginning on page 29. 
pygp y

more informed decisions about your medical treatment. 

Researchers continue to pursue new treatment options—and you

health needs may change over time—so once again we encoura

to bring your questions and concerns to your doctor and health 

team for discussion. 

28 
Resources 

and Additional 

Information 
Resources and A
y

might qualify: 

• Talk with your health care provider 

• Contact the NIH (National Institutes of Health) Patient Rec

Public Liaison Office at 1-800-411-1222 

• Review NIAD’s HIV and Emerging Infectious Diseases Pro

information at www.niaid.nih.gov/clinicalstudies/HIVand

• View the listing of current clinical trials seeking patient vo

www.clinicaltrials.gov and www.CenterWatch.com 

Smoking Cessation 

Smokefree.gov 

Telephone: 1-800-QUITNOW (1-800-784-8669) 

http://smokefree.gov 

National Network of Tobacco Cessation Quitlines 

1-800-QUITNOW (1-800-784-8669) / TTY 1-800

http://cancercontrol.cancer.gov/TCRB/national_q

American Cancer Society (ACS) 

1-800-ACS-2345 (1-800-227-2345) 

http://www.cancer.org 

American Lung Association 

1-800-LUNG-USA (1-800-586-4872) 

http://www.lungusa.org 
More Information Sources 

AIDSInfo 

P.O. Box 6303 

Rockville, MD 20849-6421 

Telephone: 1-800-HIV-0440 (1-800-448-0440) 

http://www.aidsinfo.nih.gov 

American Diabetes Association 

1701 North Beauregard Street 

Alexandria, VA 22311 

Telephone: 1-800-DIABETES (1-800-342-2383) 

http://www.diabetes.org 

American Dietetic Association 

Washington, D.C. Office 

1120 Connecticut Avenue, NW 

Suite 480 

Washington, DC 20036 

Telephone: 1-800-877-0877 

http://www.eatright.org 

American Heart Association 

Greater Washington Region 

4301 North Fairfax Dr., Suite 530 

Arlington, VA 22203 

Telephone: 703-941-8500 or 1-800-242-8721 

http://www.americanheart.org 

30 
http://www.aladc.org 

National AIDS Treatment Advocacy Project (NATA

580 Broadway, Suite 1010 

New York, NY 10012 

Telephone: 1-888-26-NATAP (1-888-266-2827) or 

212-219-0106 

http://www.natap.org 

NHLBI (National Heart, Lung, and Blood Institute) 

NHLBI Health Information Center 

P.O. Box 30105 

Bethesda, MD 20824-0105 

Telephone: 301-592-8573 

http://www.nhlbi.nih.gov 

NIAID (National Institute of Allergy and 

Infectious Disease) 

Office of Communications and Public Liaison 

6610 Rockledge Drive, MSC 6612 

Bethesda, MD 20892-6612 

Telephone: 1-866-284-4107 

http://www.niaid.nih.gov 
Building 31, Room 9A06 

31 Center Drive, MSC 2560 

Telephone: 301-496-3583 

Bethesda, MD 20892-2560 

http://www.niddk.nih.gov 

NIH (National Institutes of Health) 

9000 Rockville Pike 

Bethesda, MD 20892 

Telephone: 1-800-448-0440 

http://www.nih.gov 

32 
Frequently Asked 

Questions (FAQs) 
Frequently Asked Questions (FAQs) 
to process nutrients. Most metabolic disorders are genetic, b

be acquired. For example, the use of highly active antiretrov

(HAART) can, in some people, increase the risk for metaboli

complications such as diabetes, hyperlipidemia, and lipody

Can my HIV medication give me diabetes? 

Studies have shown that HIV patients taking HAART may be 

risk for type 2 diabetes because the medication may interfe

body’s ability to absorb blood sugar. Type 2 diabetes can b

with diet, exercise, and medication. More serious complicat

heart disease, can result if type 2 diabetes is not treated. 

What are lipids and what do they have to do with my HIV 

Lipids are the fat—such as cholesterol and triglycerides—in 

Some HIV patients taking HAART may experience an increa

blood’s lipid levels. Although the benefits of HAART have be

greatly outweigh the risks, you still need to be aware of this 

have your lipid levels monitored at least once a year. 

My doctor tells me that some of my labs are abnormal, e

ones measuring sugar and fat levels. What causes this? 

Changes in your sugar and fat levels can be linked to drug 

associated with long-term use of HAART. The long-term impa

complications is unknown, but they can affect your daily life 

threat to your cardiovascular health. While the metabolic co

(including changes in your sugar and fat levels) have been s

increase the risk of developing heart disease, studies have s

benefits of HAART far outweigh the risks. 
• Quitting smoking 

• Maintaining a healthy, low-fat diet 

• Exercising for just 30 minutes a day 

• Limiting the amount of alcohol you drink 

I look different since I started HIV medication. Are the med

responsible for my change in appearance? 

You may notice that parts of your body look like they have lost o

weight. The most common areas where fat is lost include your fa

arms, legs, and buttocks. The most common areas where fat acc

include the back of your neck, upper shoulders, abdomen, and 

This change in fat distribution is called lipodystrophy. Studies su

lipodystrophy is associated with taking antiretroviral medication

What can I do about these changes? 

Unfortunately, there are no simple lifestyle changes to completely 

counteract the effects of lipodystrophy on your body. However, a 

diet and a daily exercise routine may help to build muscle and 

accumulation. 

Are these changes reversible? 

There are currently no clearly effective treatments for lipodystrop

some cases, plastic surgery can be performed to lessen the sign

lipodystrophy. However, this surgery can be expensive and may 

covered by your insurance. 

34 
Some possible questions to ask your doctor include: 

• Can changing my antiretroviral therapy help reverse lipod

• What are my risks of developing lipodystrophy? 

• What are you recommendations for treating lipodystrophy

• How does lipodystrophy impact my overall health? 

This is a lot of information. Is there someone I can talk w

will walk me through it? 

You may want to start with AIDSinfo, an organization that o

HIV/AIDS treatment, prevention, and research. Their toll-free 

1-800-448-0440 or you can visit them online at http://aids

There is also a list of other organizations and resources in th

starting on page 29. 
36 
Glossary 

(Definition of Terms) 
Glossary (Definition of Terms) 
py 

Atherosclerosis 

Autoimmune 

disease 

Bioelectrical 

impedance analysis 

Carbohydrates 

Cardiovascular 

system 

(or circulatory system) 

deterioration, and improve surv

quality of life. 

A disease affecting arterial blo

(blood vessels that carry oxyge

to your body) that is caused by 

formation of fatty deposits (plaq

arteries – it is commonly referre

"hardening" of the arteries. 

A disease in which the body p

immune response to attack its o

A commonly used process for e

body composition by showing 

an electrical current to move th

tissues, which provides an estim

body water (TBW). TBW can b

estimate fat-free body mass and 

Sugars and starches that the bo

down into glucose and uses for 

The organ system that moves s

and from cells; a network inclu

heart, lungs, and blood vessels 

nutrients and oxygen to the bo
liver that is an essential part of cell 

and nerves. Cholesterol plays an im

part in many of the body’s process

is best known for its association wi

cardiovascular disease. Cholestero

from two sources: your body and fo

Some foods that may contribute to 

cholesterol levels include eggs, she

and saturated animal fat. 

Clinical trial A research study that evaluates new 

drugs, medical devices, or other m

interventions on patients in a scient

controlled setting. 

Computed 

tomography 

(CT) scan 

A medical imaging method that ma

three-dimensional image of the insi

objects (such as bone and organs) 

large series of two-dimensional x-ray 

Decreased bone 

mineral density 

Occurs when minerals are taken aw

from your bones and they become 

and less dense, which makes them 

and increases their risk of fracture. 

Diabetes 

(or diabetes mellitus) 

A metabolic disorder characterized 

hyperglycemia (high glucose or blo

sugar), among other signs. Type 1 

diabetes is an autoimmune disease 

which the body’s immune system at

the insulin-producing beta cells in t

pancreas and destroys them. 

38 
Dual energy x-ray 

absorptiometry 

(DEXA) scan 

Glucose 

Heart attack 

must take insulin daily to live. T

diabetes is the most common ty

associated with HAART. When 

diabetes is diagnosed, the pan

usually producing enough insu

unknown reasons, the body ca

insulin effectively – a condition 

resistance. After several years, 

production decreases. The resu

for type 1 diabetes – glucose b

the blood and the body cannot 

efficient use of it. 

A test that uses two different lo

beams to estimate the bone de

spine and hip. This test can als

your body fat. 

A simple sugar found in the blo

your body's main source of ene

Occurs when the blood supply t

the heart is interrupted and the 

oxygen shortage causes damag

potential death of heart tissue. I

emergency and the leading cau

for both men and women all ov
disease) 

Hepatitis C 

High-density 

lipoprotein 

cholesterol (HDL-C) 

Hormone 

Usually, the term “heart disease” re

coronary artery disease – a “harde

the arteries that supply blood to the 

Over 71.3 million Americans have 

cardiovascular problems. It is the n

one cause of death and disability i

United States and most European c

You can decrease your chances of d

heart disease by eating healthy, ex

and not smoking. 

An infectious, viral disease caused 

called Hepatitis C virus (HCV) – the 

can cause liver inflammation that o

no symptoms, but can result later in 

(scarring of the liver) and liver canc

Lipoproteins of different density tha

cholesterol to and from the body's 

and the liver. It is thought that HDL-

removes cholesterol from arteries a

transports it back to the liver – the 

reason why HDL-C is sometimes ca

"good cholesterol." A high level of 

seems to protect against cardiovasc

diseases, and low HDL-C levels inc

the risk for heart disease. 

A product of cells that circulates in 

blood and acts as a messenger bet

cells or groups of cells. 

40 
gg

Hyperlipidemia 

Hypertension 

(high blood pressure) 

Hypolipidemic 

agents 

Hypothyroidism 

Insulin 

Lactic acidosis 

bloodstream. It is one of the cla

of diabetes. 

An increase in the amount of fa

cholesterol and triglycerides, in 

A medical condition where the 

pressure is elevated most of the 

Drugs that lower total cholester

triglycerides, and/or increase 

cholesterol). 

Caused by insufficient producti

hormone by the thyroid gland. 

A hormone that regulates the w

body breaks down and uses ca

and helps the body use glucose 

Caused by the buildup of lactic 

body. Cells produce lactic acid 

use glucose for energy if there 

oxygen. The signs of lactic acid

deep and rapid breathing, vom

abdominal pain. Some anti-HIV 

(antiretrovirals) may increase th

developing lactic acidosis. 
triglycerides, high-density lipoprote

and low-density lipoprotein (LDL) ch

Lipodystrophy A medical condition characterized 

abnormal distribution of the body's 

("Lipo" means "fat" and "dystrophy

"abnormal or degenerative conditio

term “lipoatrophy” is used when de

the loss of fat from one area (usual

face) and “hyperadiposity” is used 

describe fat accumulation. 

Lipoma A common, benign (not life-threaten

composed of fatty tissue. Lipomas a

the touch, sometimes movable, and 

painless. They grow very slowly an

not been found to become cancero

Low-density 

lipoprotein (LDL) 

cholesterol 

Lipoproteins that carry fatty acid m

in the blood and around the body. 

commonly referred to as bad chole

because high LDL levels can lead to 

cardiovascular disease. 

Magnetic resonance 

imaging (MRI) 

A non-invasive method used to mak

of the inside of an object. MRIs do 

any radiation, but instead use stron

magnets to make your body’s atom

“stand up and dance.” 

42 
p

Omega-3 fatty acids 

Pancreatitis 

Protease inhibitor 

Pancreatitis 

Stroke 

Triglycerides 

that nutrients can be processed 

Complications occur when som

interferes with this process. 

Benefit the heart of healthy peo

who have heart disease or are 

getting heart disease. 

Inflammation of the pancreas. 

A class of medication used to t

prevent infection by viruses, su

and Hepatitis C. 

A serious brain injury in which 

supply to a part of the brain is 

Stroke is a medical emergency 

cause permanent brain damag

death if not diagnosed and tre

away. It is the third leading ca

and the leading cause of adult 

in the United States and indust

European nations. 

Formed from fatty acids as the 

diet high in fat and sugar. 
We

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