CCO Management Series
Insulin Resistance and Body Shape Changes in HIV-Infected Patients
New Insights Into the Management of Insulin Resistance in HIV-Infected Patients: Focus on Etiology and Epidemiology
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Module 1 of 4
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CME Program Director:
John P. Phair, MD
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 Topics covered include:
- Introduction
- Importance of Insulin Resistance and Prediabetes
- Etiology: Direct Drug Effects
- Mechanisms of PI-induced Insulin Resistance
- Etiology: Indirect and Non-PI Effects
Learning Objectives
Upon completion of this activity, participants should be able to:
Describe the effects of antiretroviral agents, particularly PIs, on the development of insulin resistance in HIV-infected patients. Discuss non-PI factors, such as lipodystrophy, and their effect on the development of insulin resistance in patients infected with HIV-1 List both "classic" and HIV-related risk factors for insulin resistance and type 2 diabetes. Review the role of nonpharmacologic and pharmacologic treatments for insulin resistance in HIV-infected patients.
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Pathogenesis and Epidemiology of Body Shape Changes Associated With HAART
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Module 2 of 4
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CME Program Director:
John P. Phair, MD
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Topics covered include:
- Introduction
- Special Considerations in Evaluating Cause of Body Fat Changes
- Characteristics of Lipoatrophy and Lipohypertrophy
- Definition of Lipodystrophy
- Etiology and Pathogenesis of Lipodystrophy
Learning Objectives
Upon completion of this activity, participants should be able to:
Distinguish between the characteristics of lipoatrophy and lipohypertrophy Review studies that have attempted to define lipodystrophy Recount data that describe an association between antiretroviral therapy and body fat redistribution Review possible mechanisms for NRTI-induced mitochondrial toxicity Discuss pathogenetic factors related to body shape redistribution
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Prevention and Clinical Management of Body Shape Changes Associated With HIV-1 Infection and Antiretroviral Therapy
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Module 3 of 4
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CME Program Director:
John P. Phair, MD
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Topics covered include:
- Body Shape Changes Associated With HIV Infection
- Treatment: Diet and Exercise
- Treatment: Human Growth Hormone
- Treatment: Insulin-sensitizing Agents
- Treatment: Switching Antiretroviral Agents
Learning Objectives
Upon completion of this activity, participants should be able to:
Review data concerning the effect of diet and exercise on fat redistribution in HIV-infected patients. Describe how growth hormone therapy and insulin-sensitizing agents affect body fat redistribution. List prevention strategies that physicians may take to prevent body fat redistribution in their patients. Discuss implications for treatment modification in preventing or reversing lipodystrophy and lipoatrophy. Explain the association between specific antiretroviral agents and fat redistribution.
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Perspectives on The Risks and Benefits Associated With Antiretroviral Therapy
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Module 4 of 4
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CME Program Director:
John P. Phair, MD
- Marshall J. Glesby, MD, PhD
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Topics covered include:
- Introduction
- Benefits of HAART
- Risks of HAART: Short-Term Toxicities
- Risks of HAART: Long-term Toxicities
- Cardiovascular Risks Associated With HAART
Learning Objectives
Upon completion of this activity, participants should be able to:
Describe how rates of mortality have changed in HIV-infected patients in the era of HAART. List short-term and long-term toxicities associated with HAART. Discuss strategies to decrease toxicities related to HAART. Recount the effects of these toxicities on adherence to and durability of antiretroviral regimens. Outline HAART effects on overall patient survival.
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Interactive Case Challenges
Lipoatrophy Management in a Male HIV-Positive Patient
CME Program Director:
John P. Phair, MD
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 Donald P. Kotler, MD, challenges participants with this interactive case concerning long-term management of lipoatrophy in a patient coinfected with HIV and hepatitis C virus and treated with HAART. Learning Objectives
Upon completion of this activity, participants should be able to:
- Identify the differences between HIV-associated body composition changes and those associated with HAART.
- Describe special treatment concerns in a patient with HIV/HCV coinfection.
- Discuss use of insulin-sensitizing agents in HIV-infected patients and their relevance in treatment of body shape changes.
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Management of Body Composition Changes in an HIV-Positive Man With Undetectable Viral Load on HAART Therapy
Program Director:
John P. Phair, MD
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Learning Objectives
Upon completion of this activity, participants should be able to:
Discuss the benefits and risks of insulin-sensitizing agents in the treatment of lipoatrophy in HIV-infected patients Contrast the benefits and potential pitfalls of using lipid-lowering agents vs treatment modification Describe the impact of specific antiretroviral agents on peripheral lipoatrophy and dyslipidemia
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Insulin Resistance in an HIV-Infected Man: Management Perspectives
CME Program Director:
John P. Phair, MD
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William Powderly, MD, challenges participants using an interactive case addressing strategies to manage insulin resistance in a patient with HIV. Learning Objectives
Upon completion of this activity, participants should be able to:
- List the metabolic effects of individual PIs
- Discuss the mechanism by which PIs may cause insulin resistance
- Describe the role of insulin-sensitizing agents in the treatment of insulin resistance in HIV-infected patients
- Compare hypotheses for the relationship between insulin resistance and body composition changes
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Tools
Balancing the Risks vs the Benefit of HAART
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This interactive tool allows you to explore the balance between the potential benefits and cardiovascular risks of antiretroviral therapy in the background of various patient and treatment-related risk factors.
Format: Adobe Flash | File size: 90 KB
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Animation
Mechanisms of Insulin Resistance in HIV-Infected Patients
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A 3D animation illustrating the body's normal insulin response, and the potential mechanisms by which HIV treatment and body shape changes in HIV-infected patients contribute to insulin resistance.
This animation and others are available for use offline from the Download Library.
To download to your own computer and use for personal or teaching purposes, click here
Format: Adobe Flash | File size: 3,359 KB
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Program in Portuguese
Disclaimer: The materials published on the Clinical Care Options Web site reflect the views of the reviewers or authors of the CCO material, not those of Clinical Care Options, LLC, the CME provider, or the companies providing educational grants. The materials may discuss uses and dosages for therapeutic products that have not been approved by the United States Food and Drug Administration. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or using any therapies described in these materials.
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Jointly sponsored by Postgraduate Institute for Medicine and Clinical Care Options, LLC.
Contact Info
Educational grant provided by:
Educational grants support only the CME-certified components of this program.
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