CLINICAL

• Insulin resistance (IR) common in people with HIV (PWH) on ART, especially older PWH.[15][14]
• Diabetes mellitus (DM) also common, with a prevalence that is at least 2x higher than in general population.[11]
• IR also caused by fat accumulation (lipodystrophy). In general population (and presumably in PWH), IR increases risk for cardiovascular disease (CVD).[10]
• Risk factors for IR/DM: ectopic fat accumulation, peripheral lipoatrophy, family Hx of DM, obesity, age, HCV, black/Hispanic race.[11][10][26]
• Consider role of other medications: corticosteroids, growth hormone, megestrol acetate, immunosuppressants, atypical antipsychotics.[20][17]
• Older PIs (IDV, full-dose RTV) have marked effects on IR.[34][24] Of the current PIs, LPV/r > DRV/r and ATV/r.[28][16] Boosting dose of RTV has not been shown to effect IR in people without HIV.[19]
• No difference seen in HOMA-IR in participants treated with the integrase inhibitors (INSTI) raltegravir versus ATV/r or DRV/r.[12]