Appendix to the German-Austrian HIV Therapeutic Guidelines: strategies for treating morphological and metabolic alterations under antiretroviral treatment (current as of December 2004).

The recommendations made in this review are based on the current clinical knowledge with regard to the origin and therapy of lipodystrophy. They should be regarded as provisional and will change with expanding knowledge. The recommendations for treating dyslipidaemia in particular are oriented closely on the American recommendations of the National Cholesterol Education Program (NCEP III), and may be regarded both by HIV practitioners and patients as excessive and too rigid. The therapeutic goals of the NCEP in the first intervention studies in HIV-positive individuals were only achieved for a small proportion of the HIV patients. In addition, preliminary results suggest a potentially higher risk of adverse events in HIV-patients under statins or fibrates. The clinical efficacy of interventions with lipid lowering drugs has not been validated in HIV-seropositive patients. However, therapeutic decisions so far have been based on data obtained in non-HIV cardiovascular intervention studies. With more and more results becoming available from the HIV patient population a revision of these recommendations will be required.