The potential drug–drug interactions that may occur in HIV-infected individuals with comorbidities such as diabetes, hypertension, dyslipidaemia and hyperuricaemia are a subject of much debate. There is clearly a risk of impaired drug tolerance and efficacy. PIs ALK signaling pathway and nonnucleoside reverse transcriptase inhibitors (NNRTIs) are all metabolised in the liver by the cytochrome (CYP) 450 system, a common metabolic pathway for many other drugs, including statins. Some PIs and NNRTIs inhibit statin excretion and therefore a lower starting dose is required. Conversely, others

reduce the efficacy of the statin, meaning that a higher dose may be needed [5]. Regular monitoring and dose titration are therefore essential in patients taking ART and statin therapy. Fibrates are not considered to potentially interact with ritonavir, or PIs in general [40]. The challenge of treating diabetes and dyslipidaemias in HIV-infected patients receiving ART, including PIs, and especially ritonavir, has been reviewed by Fantoni [41]. Drug–drug interactions may occur between ritonavir and rosiglitazone in the management of diabetes, leading to a reduced metabolism and potential overdosage of the anti-diabetic drug. Knowledge of when to refer to other specialist colleagues has become very important; similarly, proactive communication of the need for lifestyle changes related

to diet, smoking, alcohol use and physical activity is paramount. Clinicians Afatinib order should be given the opportunities to educate each other, within their own hospitals, and HIV physicians should be discouraged from working in isolation. Programmes such as the ongoing HIV and the Body initiative (http://www.hivandthebody.com) can help address some of these issues. As well as a programme of international and national medical education meetings, expert-led treatment and management algorithms are available for physicians

to download from http://www.hivandthebody.com and use in everyday practice. There is an increasing Protirelin need for ongoing monitoring of interventions that aim to reduce the risk of development and progression of comorbidities in individuals infected with HIV. Awareness of the findings of clinical endpoint studies, such as fracture prevalence studies, and the use of surrogate markers in CVD are important in achieving a clear picture of the impact of the intervention. Risk stratification tools are not sufficient to demonstrate the effectiveness of an intervention. Patient-related outcomes and the evaluation of quality of life are also important, particularly in the assessment of interventions to address comorbidities that affect body image, such as lipodystrophy [9]. An ageing HIV-infected population demands a new approach to the management of HIV infection.