The EACS and BHIVA guidelines have a similar approach in relation to the threshold for screening for risk of fractures. Both recommend that patients should only be considered for screening with DXA scans when there is a significant risk. The BHIVA guidelines
define this as those with an intermediate or high FRAX score, and all men and women over 70 and 65 years of age, respectively. BHIVA guidelines recommend that a 3-yearly assessment of risk factors becomes Panobinostat nmr relevant at 50 years of age or above, and should be additionally performed for this age group before and after the use of ART. EACS guidelines suggest a 2-yearly follow-up in those > 40 years of age, again reserving DXA for those considered to have significant risk. Both guidelines focus on specific time-points relating to HIV therapy: baseline (the point at which the patient engages in care); pre-ART initiation; at ART initiation; on ART (6–12-monthly for most comorbidities, except for bone in which
the gradual nature of the change allows for screening on average every 2–3 years). Regular screening would identify those HIV-infected individuals most at risk of developing metabolic comorbidities and means that appropriate interventions can be initiated to reduce modifiable risk factors. Lifestyle interventions will be adequate for most individuals. Pharmacological management is indicated for the minority, but for these, the potential risk reduction can be large, with a commensurate mitigation of morbidity and mortality. Table 1 summarizes the assessments and treatment recommendations Apoptosis Compound Library in vitro for noninfectious comorbidities in the current EACS guidelines. + + + + + + +/ + + + + Annual 3–12 months + + + + + + Annual 3–12 months Annual + + + + + 6–12 months 2 years As indicated 1–3 years 1–3 years 1–3 years 6 months ALP, alkaline phosphatase; ALT, alanine amino transferase; aMDRD, abbreviated modification of diet in renal disease; ART, antiretroviral therapy; AST, aspartate amino transferase; CKD, chronic
kidney disease; CVD, cardiovascular disease; DXA, dual energy Sunitinib solubility dmso X-ray absorptiometry; ECG, electrocardiogram; eGFR, estimated glomerular filtration rate; FBC, full blood count; FRAX, fracture prediction tool; G6PD, glucose 6-phosphate dehydrogenase; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; MSM, men who have sex with men; PI, protease inhibitor; TC, total cholesterol; TG, triglycerides; UP/A, urine protein/albumin ratio; UP/C, urine protein/creatinine ratio. HIV infection may contribute to an increase in cardiovascular risk through several potential mechanisms, including increased systemic inflammation, pro-atherogenic changes in serum lipids, increased systemic hypercoagulability and decreased vascular reactivity .