Treating HIV Is the Easy Part

How do you manage a potential change in HIV treatment when the patient's problem list also includes HCV infection, cirrhosis, obesity, diabetes, substance abuse, and depression?

A 52-year-old, HIV-infected Latino man with type 2 diabetes mellitus, hepatitis C virus (HCV) infection, and a history of injection-drug use comes to clinic for routine follow-up, expressing concern about recent weight gain and poorly controlled blood sugar. He is on insulin (40 units daily with a sliding scale), with postprandial blood sugar levels ranging from 200 to 400 mg/dL. His total cholesterol level is 113 mg/dL; triglycerides, 74 mg/dL; HDL cholesterol, 43 mg/dL; and LDL cholesterol, 55 mg/dL. He has no clinical evidence of active cardiovascular disease and does not smoke. His weight has increased to 202 pounds (92 kg) over the past year, giving him a body-mass index of 34.7 kg/m².

The patient's current antiretroviral regimen consis…

Treating HIV Is the Easy Part

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