Diabetes Mellitus and Insulin Resistance
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- Insulin resistance (IR) common in HIV+ pts on ART.
- Diabetes mellitus (DM) less common, but still 2-4x higher than in general population.
- IR also caused by fat accumulation (lipodystrophy). In general population (and presumably in HIV+ pts), IR increases risk for coronary artery disease.
- Risk factors for IR/DM: abdominal fat accumulation, peripheral lipoatrophy, family Hx of DM, obesity, age, HCV, low CD4 nadir, 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. Independent effect of low dose RTV on IR controversial.