Non-infectious co-morbidities include cardiovascular, renal, hepatic, metabolic, neoplastic, bone pathologies and depression. Although HIV and other infections may be involved in their pathogenesis, these guidelines focus on preventive and/or management principles other than use of antivirals and other anti-infectious agents in adults and adolescent HIV-infected persons.

These co-morbidities are becoming increasingly important for HIV-infected persons as a consequence of increased life expectancy resulting from effective ART. Additionally, several demonstrated and proposed HIV-associated risk factors may contribute to their development including immune activation, inflammation and coagulation associated with (uncontrolled) replication of HIV, co-infections (e.g. HCV), ART itself and persistent immunodeficiency.

Health care professionals involved with the care of HIV-infected persons who are not familiar with the use of ART should consult HIV specialists before introducing or modifying any type of treatment that HIV-infected patients receive.

Conversely, many HIV physicians are not specialists in non-infectious co-morbidities, and should seek expert advice where appropriate in the prevention and management of such conditions. Situations where consultation is generally recommended are indicated in these guidelines.

Preventing or managing these diseases in HIV often involves polypharmacy, which increases the risk of suboptimal adherence and hence may compromise the continued benefit of ART. Additionally, the possibility of drug-drug interactions with ART should be carefully considered prior to introducing any treatment. Several web-sites exist for this purpose: www.HIV-druginteractions.org, www.HIVpharmacology.com, www.AIDSinfo.nih.gov.

These guidelines are intended to provide the best guide to clinical management, and it is recognised that the level of evidence to support the advice varies. Indeed, there is limited evidence from randomised controlled trials on best management of non-infectious co-morbidities in HIV. As a result current management is mainly derived from general medical guidelines. These guidelines therefore represent the collective consensus opinion of a panel of experts in the field of HIV and the respective range of co-morbidities, and no attempt to rate the underlying evidence and strength of the panel’s recommendations was undertaken.

Dependent on future clinical research findings, these guidelines will be regularly updated as required. The online version of guidelines, at www.europeanaidsclinicalsociety.org, contains more detailed information, links to other relevant websites and will be regularly updated.

The current guidelines highlight non-infectious co-morbidities that are seen frequently in the routine care of HIV-infected persons and those for which specific issues should be considered. Other related conditions in the management of HIV disease that are not extensively discussed, but may be included in future versions are:

• Sexual dysfunction. This is frequently encountered and often requires a multidisciplinary approach for its management that may include both expert psychological counselling and medical interventions.
  
• Hypogonadism,
  
• Other women’s health issues, and
  
• Neuropathy which may be caused by infections (e.g. HIV), some ARV (see p. 37), other neuropathic drugs, and by metabolic diseases (eg. diabetes).