HIV Therapy and Diabetes Risk

The use of combination antiretroviral therapy (cART) has yielded dramatic clinical benefits for individuals with HIV infection. Benefits include suppression of viral load, improvement in CD4 lymphocyte counts, decrease in the number of opportunistic infections and length of hospital stay, and reduction in AIDS-related mortality (1,2). These advantages have come at the price of increased incidence of unanticipated adverse metabolic effects, including insulin resistance, diabetes, dyslipidemia, and lipodystrophy (2). The clinical presentation of antiretroviral-associated diabetes is consistent with that of type 2 diabetes, and evidence of islet autoimmunity is distinctly uncommon in patients with antiretroviral-associated diabetes (3). Early studies fostered the understanding that inclusion of HIV-1 protease inhibitors most likely accounts for the adverse metabolic effects. The association between protease inhibitors and diabetes was further strengthened by studies showing that switching patients to other regimens improved the hyperglycemia and hyperlipidemia observed during use of protease inhibitor–containing regimens. Focusing almost exclusively on the role …