Baylor University Medical Center Proceedings April 2014, Volume 27, Number 2 | Page 31

would be better choices in a patient with diabetes or a patient at risk for diabetes. Adult HIV guidelines list NRTIs (stavudine, zidovudine, abacavir), the NNRTI efavirenz, and all ritonavir-boosted protease inhibitors as having the risk of increasing lipid levels (3). A baseline fasting lipid profile should be drawn prior to therapy initiation, and the risk of dyslipidemia should be assessed. Lipid levels should be monitored annually, and it is not unreasonable to check a fasting lipid profile 4 to 8 weeks after starting a new regimen (3). Due to the risk of cardiovascular disease in Native Americans, it may be prudent to avoid the above regimens if possible; however, HIV should be treated despite the risk of vascular disease (5). When choosing a regimen for a Native American HIVpositive patient, it is important to assess possible adverse effects as they will affect or precipitate comorbid conditions (6). Currently, three of the four preferred regimens supported by adult HIV treatment guidelines contain a component that could precipitate diabetes mellitus, dyslipidemia, or psychiatric comorbid issues. The preferred integrase inhibitor regimen and the alternative non-efavirenz-containing NNRTI regimens appear to be favorable regimens to use in patients at risk for these conditions. The risk of precipitating a comorbid adverse event should not deter treatment of HIV. Monitoring should be done in accordance with current guidelines to reduce and prevent medication complications. Newer therapies on the market, such as elvitegravir/ cobicistat or dolutegravir, may also have a role in these patients. Centers for Disease Control and Prevention. HIV Surveillance Report 2010. Atlanta, GA: CDC, March 2012. Available at http://www.cdc.gov/hiv/ topics/surveillance/resources/reports/. 2. Schiller JS, Lucas JW, Ward BW, Peregoy JA. Summary health statistics for U.S. adults: National Health Interview Survey, 2010. Vital Health Stat 2012;10(252):1–207. 3. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Rockville, MD: US Department of Health and Human Services. Available at http://www.aidsinfo.nih.gov/contentfiles/ lvguidelines/adultandadolescentgl.pdf. 4. Bozzette SA, Ake CF, Tam HK, Chang SW, Louis TA. Cardiovascular and cerebrovascular events in patients treated for human immunodeficiency virus infection. N Engl J Med 2003;348(8):702–710. 5. Brown TT, Cole SR, Li X, Kingsley LA, Palella FJ, Riddler SA, Visscher BR, Margolick JB, Dobs AS. Antiretroviral therapy and the prevalence and incidence of diabetes mellitus in the multicenter AIDS cohort study. Arch Intern Med 2005;165(10):1179–1184. 6. De Wit S, Sabin CA, Weber R, Worm SW, Reiss P, Cazanave C, El-Sadr W, Monforte Ad, Fontas E, Law MG, Friis-Møller N, Phillips A; Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study. Incidence and risk factors for new-onset diabetes in HIV-infected patients: the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study. Diabetes Care 2008;31(6):1224–1229. 1. Avocations Photo copyright © Jed Rosenthal, MD. Dr. Rosenthal is a cardiologist in Dallas, Texas (e-mail: [email protected]). April 2014 Characteristics of Native Americans with HIV and implications for care 105