Diabetes Mellitus and Insulin Resistance
- Insulin resistance (IR) common in people with HIV (PWH) on ART, especially older PWH.
- Diabetes mellitus (DM) also common, with a prevalence that is at least 2x higher than in general population.
- IR also caused by fat accumulation (lipodystrophy). In general population (and presumably in PWH), IR increases risk for cardiovascular disease (CVD).
- Risk factors for IR/DM: ectopic fat accumulation, peripheral lipoatrophy, family Hx of DM, obesity, age, HCV, black/Hispanic race.
- Consider role of other medications: corticosteroids, growth hormone, megestrol acetate, immunosuppressants, atypical antipsychotics.
- Older PIs (IDV, full-dose RTV) have marked effects on IR. Of the current PIs, LPV/r > DRV/r and ATV/r. Boosting dose of RTV has not been shown to effect IR in people without HIV.
- No difference seen in HOMA-IR in participants treated with the integrase inhibitors (INSTI) raltegravir versus ATV/r or DRV/r.
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