HIV Metabolic Complications — SCE Infectious Diseases MCQ

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ModerateHIV MedicineHIV Metabolic ComplicationsSCE Infectious Diseases

A 36-year-old man with HIV (CD4 520, VL <50 on DTG/TAF/FTC) develops new-onset insulin resistance, truncal obesity, and dyslipidaemia. His pre-ART metabolic profile was normal. He has gained 18 kg since starting ART 3 years ago. Which investigation is most important to exclude a non-ART cause of his metabolic syndrome?

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Correct answer: A — HbA1c, fasting lipids, and assessment for Cushing syndrome if clinically indicated

While INSTI-associated weight gain (particularly DTG and BIC, augmented by TAF) is a recognised phenomenon, clinicians must also exclude alternative causes of metabolic syndrome. A comprehensive metabolic workup including HbA1c, fasting lipids, and consideration of secondary causes (Cushing syndrome if features suggest) is essential. BHIVA 2025 acknowledges weight gain as a growing concern but does not currently recommend ART switching solely for weight gain — lifestyle interventions and metabolic management are prioritised.

Reference: BHIVA 2025 – ART guidelines (2025 interim update); EACS 2025 – Metabolic complications