Insulin resistance and HIV infection: a review

Abstract

Highly active antiretroviral therapy (HAART) has markedly improved the prognosis of people with HIV infection. However, there are long-term side effects associated with HAART. Alterations in metabolic parameters are common and include hyperlipidaemia and insulin resistance (IR), either in isolation or as part of the lipodystrophy and metabolic syndromes. Insulin resistance is common in HIV-infected people, particularly among those being treated with protease inhibitor therapy. The prevalence of hyperglycaemia and diabetes mellitus is significantly higher in people with HIV infection being treated with antiretrovirals (ARVs), as compared with the general population. Hyperglycaemia is an important risk factor for the development of secondary pathology, including cardiovascular disease. It is therefore important to consider the effects of IR in HIV-infected individuals, and take measures to prevent or manage it appropriately. There is limited evidence for the benefit of pharmacological interventions for IR alone although the metabolic changes and body shape changes of lipodystrophy might benefit from the combined use of metformin with exercise. At present, therefore, it is best to concentrate on preventative measures, including lifestyle modification, the careful selection of ARV drugs, and changing drug combinations where appropriate.

Infection par le virus de l’immunodéficience humaine et diabète : vécu et qualité de vie des patients confrontés à deux maladies chroniques

“…Le VIH et les antirétroviraux sont pourvoyeurs de lipodystrophie, d'hypertriglycéridémie et d'insulinorésistance. Le diabète est donc une comorbidité importante dans la population infectée par le VIH [6][7][8][9][10][11][12]. La moitié des décès des patients séropositifs pour le VIH est liée à une cause non-classant SIDA, principalement cardiovasculaire [13][14][15].…”

Analysis of endoplasmic reticulum stress in placentas of HIV-infected women treated with protease inhibitors

“…Protease inhibitor inducible insulin resistance is another adverse effect known to be caused by HIV medications [32] and may further aggravate the phenomenon of gestational diabetes that can occur in pregnant women [33]. Since elevated glucose levels are also known to promote endoplasmic reticulum stress [34], it may be of interest to include blood glucose and lipid levels in further studies for generation of a more comprehensive overview of factors that may contribute to placental endoplasmic reticulum stress in HIV-infected mothers treated with protease inhibitors.…”

Tuberculosis, HIV/AIDS and Diabetes – Is it Time to Think Together?

“…Based on the available evidence, it is clearly understood that, diabetes predisposes to TB [2,13], whereas with limited evidence TB may also predispose to diabetes [40]. ART for HIV/AIDS may increase the risk of metabolic syndrome and thus predispose to DM (Figure 1) [27,30]. Hence, we call for the action of considering all the three diseases together for diagnosis and management to improve the case detection, early treatment and possible prevention.…”

“…Hence, PLHA taking ART frequently presents with diabetes and other metabolic complaints [29]. The prevalence of hyperglycemia and diabetes mellitus is significantly higher in PLHA being treated with ART, as compared with the general population [29][30][31][32]. Therefore, as number of PLHA increases, the incidence of HIV-associated diabetes is also bound to grow.…”