Managing Comorbid Type 2 Diabetes Mellitus and HIV

Approximately 14% of patients infected with human immunodeficiency virus (HIV) also have type 2 diabetes mellitus. That number is expected to rise as the population of HIV-infected patients ages and develop associated chronic comorbidities.

Approximately 14% of patients infected with human immunodeficiency virus (HIV) also have type 2 diabetes mellitus (DM). That number is expected to rise as the population of HIV-infected patients ages and develop associated chronic comorbidities. Some evidence indicates HIV is an independent risk factor for DM. Multiple factors related to HIV and its treatment are associated with DM. For example, some medications use to treat HIV, comorbid hepatitis C infection and low testosterone can cause diabetes. This clinical challenge—comorbid HIV and DM—is covered in an article published ahead of print in Clinical and Infection Disease.

The authors encourage screening if DM is suspect, and prefer fasting blood glucose for diagnosis, since HbA1C may underestimate glycemia in HIV-infected individuals.

The American Diabetes Association and the European Association for the Study of Diabetes DM have updated their DM treatment guidelines in recent years, and both emphasize individualization of DM medication therapy and treatment goals. This is as important in patients with HIV as it is in the general population. The tried-and-true approaches (lifestyle modification, weight loss, etc) are important in HIV patients.

Medication is a reasonable next step; metformin is the preferred first-line agent. This review discusses various drug classes and their advantages at length. Here, their recommendations are consistent with those of the guidelines addressed above—maintaining HbA1C below 7 unless comorbidities prevent tight control, and early interventions to attain that goal.

The authors note that switching antiretroviral therapy is a possible intervention if patients are taking lopinavir/ritonavir or thymidine analogs (zidovudine, stavudine).

Last, they address CVD risk reduction in HIV-infected patients with DM. This is critical, since HIV patients already have elevated cardiovascular risk. Overall, this article highlights the distinctive problems in this patient population and offer guidance based on current knowledge.