Endocrine Abstracts

Introduction: Human immunodeficiency virus (HIV) infection and certain antiretroviral (ARV) treatments are associated with an increased risk of developing certain chronic comorbidities including type 2 diabetes, which is more prevalent in HIV-infected individuals. The coexistence of diabetes and HIV infection makes the standard of care more complex. The objective of this work is to discuss the relationship between these two comorbidities and to update physicians on the diagnosis of type 2 diabetes (T2DM) in HIV-infected patients.

Case presentation: A 40-year-old female patient, followed for HIV infection for 23 years under antiretroviral treatment, including protease inhibitors (PIs) and nucleoside analogues (NRTIs). Eight years later, the patient consulted with vaginal pruritus with profound asthenia. The workup showed fasting hyperglycemia at 3 g/l with hbA1c at 12%. She was put on insulin therapy and metformin with good evolution.

Discussion: It has been reported that diabetes is up to four-fold more common in HIV infected patients on retroviral therapy than in HIV seronegative patients. It is noted that glucose intolerance and insulin resistance are the main mechanism, the exact causes of which have not yet been defined, but several risk factors for the development of diabetes in HIV-infected individuals have been identified, such as duration of HIV infection, viral load, low CD4 count, and inflammation caused by HIV. However, the main factor that contributes to hyperglycemia in HIV is iatrogenic. Certain classes of AVR have been shown to increase the likelihood of developing diabetes in HIV-infected patients, such as protease inhibitors (PIs) and nucleoside analogues (NRTIs). And since HIV-infected patients have a more rapid turnover of red blood cells. It is suggested that fasting blood glucose should be used as a screening and diagnostic tool for diabetes in these patients, and postprandial blood glucose or oral glucose tolerance testing can also be performed as part of the screening measures.

Conclusion: As a result, the least toxic ARVs should be chosen and metabolic abnormalities should be detected early. Management should be multidisciplinary.