Stop Diabetes Before It Starts

By Michelle Garcia

Originally published on Advocate.com August 31 2011 3:00 AM ET

 People with hiv who are currently on older antiretroviral therapy may want to also keep tabs on the possibility of becoming diabetic or talk to their doctor about updating their treatments.

A new study by St. Luke’s-Roosevelt Hospital Center and Columbia University in New York City recommends that people with HIV be screened for diabetes routinely when starting antiretroviral therapy, with a follow-up three to six months later, and then annually. The study authors, who reviewed previous research on HIV and diabetes, made this recommendation because the rate of diabetes among HIVers on protease inhibitors is between 7% and 13%, compared to around 3% for previously untreated people with HIV, according to The AIDS Beacon.

Not all treatments had the same correlation with diabetes. Among protease inhibitors, Crixivan was linked to a higher risk of diabetes, while Reyataz appeared to have no link. For Kaletra, some research showed it to be associated with a higher risk of insulin resistance, one of the indicators of diabetes, while other studies showed no effect. Other classes of drugs, particularly older nucleoside reverse transcriptase inhibitors like Zerit, Retrovir, and Videx, may also increase the chances of becoming diabetic. Some research found that the risk of high insulin levels increased 8% annually with NRTI use. However, the newer NRTI Viread, which is also a component of Atripla and Truvada, has not been tied to heightened risk of diabetes.

The International AIDS Society has specific advice for HIVers trying to avoid diabetes; among them, it encourages doctors to monitor a patient’s glucose and lipid levels before and during antiretroviral treatment. It also recommends that patients with a family history of diabetes be tested and, if they have the disease, manage it with a healthy diet and regular exercise (and medication, if needed).