Ten year type 1 Diabetic with positive HIV for 4 monthswith

Question

I'm aware of developing diabetes as a complication of AIDS therapy (anti-retroviral and protease inhibitors), but need information on the effect of HIV infection on pre-existing Type 1 diabetes and vice-versa. Since diabetes is immunosuppressive, will infection with HIV be more devastating than in a non-diabetic? In other words, how much more difficult is HIV for a diabetic--how do they interact, both independently and in consideration of the medication side effects?

Answer

Real good question. No clear answer however. The interest in diabetes has mainly occured in the last 5 years (post protease inhibitors) becuase of the now well confirmed relationship of PIs and the development of insulin resistrance and diabetes. I have seen essentially nothing in the last 20 years on the effects of HIV on diabetes (though I may have missed something). Prior to 5 years ago long-term survival with HIV was only a theoretical possibility so I don't think we paid much attention to issues like diabetes, cholesterol and so forth. Now that we have found that antiretroviral therapy is associated with complications (insulin resistance, truncal obesity, hyperlipidemia) that in the absence of HIV (and by extrapolation in the presence of HIV) definitely increase the risk of heart disease we must pay more attention. In the presence of pre-existing diabetes it is likely that antiretroviral therapy could cause difficulty in controlling diabetes and could add to the risk of heart disease because of this and the other related complications. But for now we do not know for sure. AF