Acquired immunodeficiency syndrome (AIDS) is a human immune system disease characterized by increased susceptibility to opportunistic infections, certain cancers and neurological disorders. The syndrome is caused by the human immunodeficiency virus (HIV) that is transmitted through blood or blood products, sexual contact or contaminated hypodermic needles. Antiretroviral treatment reduces the mortality and the morbidity of HIV infection but is increasingly reported to be associated with increasing reports of metabolic abnormalities. The prevalence and incidence of diabetes mellitus in patients on antiretroviral therapy is high. Recently, a joint panel of American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) experts updated the treatment recommendations for type 2 diabetes (T2DM) in a consensus statement which provides guidance to health care providers. The ADA and EASD consensus statement concur that intervention in T2DM should be early, intensive, and uncompromisingly focused on maintaining glycemic levels as close as possible to the nondiabetic range. Intensive glucose management has been shown to reduce microvascular complications of diabetes but no significant benefits on cardiovascular diseases. Patients with diabetes have a high risk for cardiovascular disease and the treatment of diabetes should emphasize reduction of the cardiovascular factors risk. The treatment of diabetes mellitus in AIDS patients often involves polypharmacy, which increases the risk of suboptimal adherence
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1. Sepkowitz KA. AIDS - the first 20 years. N Engl J Med 344: 1764-1772 2001.
2. Weiss RA. How does HIV cause AIDS? Science 260: 1273-1279 1993.
3. World Health Organization Departement of HIV/SIDA Data and statists accessed at: www.who.int/hiv.
4. Department of Monitoring and Evaluation of HIV/SIDA in Romania Evolution of HIV/AIDS infection in Romania 31 December 2012 accessed at: www.cnlas.ro/contact.html.
5. Brown TT Cole SR Li X et al. Antiretroviral therapy and the prevalence and incidence of diabetes mellitus in the multicenter AIDS cohort study. Arch Intern Med 165: 1179-1184 2005.
6. Shen Y Wang Z Liu L Zhang R Zheng Y Lu H. Prevalence of hyperglycemia among adults with newly diagnosed HIV/AIDS in China. BMC Infect Dis 13: 79 2013.
7. Behrens GM Boerner AR Weber K et al. Impaired glucose phosphorylation and transport in skeletal muscle cause insulin resistance in HIV-1-infected patients with lipodystrophy. J Clin Invest 110: 1319-1327 2002.
8. Shao J Yamashita H Qiao L Draznin B Friedman JE. Phosphatidylinositol 3-kinase redistribution is associated with skeletal muscle insulin resistance in gestational diabetes mellitus. Diabetes 51: 19-29 2002.
9. Mynarcik DC Combs T McNurlan MA Scherer PE Komaroff E Gelato MC. Adiponectin and leptin levels in HIV-infected subjects with insulin resistance and body fat redistribution. J Acquir Immune Defic Syndr 31: 514-520 2002.
10. *** Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 20: 1183-1197 1997.
11. World Health Organization. Definition Diagnosis and Classification of Diabetes Mellitus and its Complications. Report of a WHO Consultation. Part 1. Diagnosis and Classification of Diabetes Mellitus. Geneva World Health Organization 1999.
12. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 25[Suppl. 1]: S5-S20 2002.
13. European AIDS Clinical Society (EACS). Guidelines: Clinical Management of Treatment of HIV Infected Adults in Europe. Version 5. November 2009 accessed at: www.eacsociety.org/Portals/0/Guidelines.
14. Greenfield S Billimek J Pellegrini F et al. Comorbidity affects the relationship between glycemic control and cardiovascular outcomes in diabetes: a cohort study. Ann Intern Med 151: 854-860 2009.
15. Matthews DR Tsapas A. Four decades of uncertainty: landmark trials in glycaemic control and cardiovascular outcome in type 2 diabetes. Diab Vasc Dis Res 5: 216-218 2008.
16. Skyler JS Bergenstal R Bonow RO et al. Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD ADVANCE and VADT diabetes trials: a position statement of the American Diabetes Association and a scientific statement of the American College of Cardiology Foundation and the American Heart Association. Diabetes Care 32: 187-192 2009.
17. American Diabetes Association. Standards of medical care in diabetes-2010. Diabetes Care 33 [Suppl 1]: S11-S61 2010.
18. American Diabetes Association Bantle JP Wylie-Rosett J et al. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care 31: S61- S78 2008.
19. American Diabetes Association. Standards of medical care in diabetes-2013. Diabetes Care 36[Suppl. 1]: S11-S66 2013.
20. European AIDS Clinical Society (EACS). Guidelines: Clinical Management of Treatment of HIV Infected Adults in Europe. Version 7. October 2013 accessed at: www.eacsociety.org/Portals/0/Guidelines.
21. Nathan DM Buse JB Davison MB et al. Management of hyperglycemia in type 2 diabetes: A consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 29: 1963-1972 2006.
22. Inzucchi SE Bergenstal R Buse JB et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 35: 1364-1379 2012.
23. European Medicines Agency. European Medicines Agency recommends suspension of Avandia Avandamet and Avaglim accessed at: www.ema.europa.eu/ema/index.jsp?curl=pages/news.
24. European Medicines Agency. European Medicines Agency clarifies opinion on pioglitazone and the risk of bladder cancer accessed at: www.ema.europa.eu/ema/index.jsp?curl=pages/news.
25. Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 285: 2486-2497 2001.