New onset Diabetes in Long Term HIV patients.

Question

As a 51y/o male and 26yr HIV+ long term survivor on Lexiva and Truvada with CD4~400/Viral Load-undetectable, I now have been told I have Diabetes based on several fasting blood sugars and HgbA1C results. Should the treatment of this Diabetes be any different and a non-HIV patient with the same diagnosis?

Answer

Basically, no. The treatment of diabetes in the setting of HIV infection mirrors that in teh un-infected individual. Oral medications such as metformin, rosiglitazone and pioglitazone are popular agents and each can be used in HIV+ folks. Metformin can cause, rarely, lactic acidosis (a dangerous build up of lactic acid in the blood) as can some HIV meds - notably d4T and ddI. As you are not on one of these 'd' drugs I would not be overly concerned about lactic acidosis.

The relationship between HIV meds and diabetes and other glucose problems is still a bit murky. Part of the problem is that diabetes is so common in the general population. If you have a family history of diabetes it may well be that you were destined to develop this disease regardless of HIV or HIV meds.

As in all diabetics, good nutrition, regular eye doctor visits, smoking cessation, foot care and keeping lipid levels low are very important to long term health.

DW