HIV and Diabetes Mellitus Course

HIV and Diabetes Mellitus Course is organized by National LGBTQIA+ Health Education Center.

Description:
Human immunodeficiency virus (HIV) infection and diabetes mellitus (DM) affect 1.2 and 34.2 million people, respectively, in the United States 1, 2. Approximately 10% of people with HIV also have DM3. Type 2 DM is more common than type 1 DM and is the focus of this fact sheet. Clinicians caring for people with HIV must be prepared to screen for and manage DM and to counsel patients at risk for DM about DM prevention.

What is the relationship between HIV, antiretroviral therapy (ART), and DM?
• People with HIV tend to gain weight after starting ART4.
• Weight gain is most prominent with integrase inhibitors, which are common components of first-line ART regimens in the United States5.
• Weight gain is also greater with regimens containing tenofovir alafenamide (TAF) in comparison to tenofovir disoproxil fumarate (TDF)6.
• Weight is a strong risk factor for DM, and as weight increases among people with HIV, the risk for DM increases more than among HIV-uninfected people at similar weights7 .

How can DM be prevented among people with HIV?
• A randomized controlled trial not focused on people with HIV showed that lifestyle interventions (losing at least 7% of weight, maintaining weight loss, and at least 150 minutes of physical activity per week) and metformin reduce progression to DM among people at risk for DM8.
• Smaller studies suggest that these interventions are also effective among people with HIV9,10.
• There is currently insufficient evidence to recommend ART changes for DM prevention among people who are virologically suppressed and otherwise tolerating ART well.

How does HIV affect treatment of DM?
• DM treatment for people with HIV is generally the same as for HIV-uninfected people. Cornerstones of treatment include diet and lifestyle modifications, metformin, and other agents (e.g., GLP-1 agonists) if metformin alone is insufficient.
• Goal glucose levels are the same regardless of HIV status.
• Dolutegravir, a common integrase inhibitor, increases metformin levels13. In people taking dolutegravir, the dose of metformin should not exceed 1000 mg/day. Otherwise, drug interactions between ART and antidiabetic agents are uncommon.

Additional details will be posted as soon as information is available.