|Insulin resistance, asymptomatic hyperglycemia, DMa
||Thymidine analogue NRTIs (d4T, ddI, ZDV)
Some PIs (IDV, LPV/r; perhaps less often ATV, ATV/r, DRV/r, TPV/r)
Weeks to months after beginning therapy; median of 60 days (adult data)
Asymptomatic fasting hyperglycemia (possibly in the setting of lipodystrophy), metabolic syndrome, or growth delay
Frank DM (polyuria, polydipsia, polyphagia, fatigue, hyperglycemia)
|Impaired fasting glucose:
ARV-treated adults: 3%–25%
Impaired glucose tolerance:
ARV-treated adults: 16%–35%
ARV-treated adults: 0.6–4.7 per 100 person-years (2- to 4-fold greater than that for HIV-uninfected adults)
Very rare in HIV-infected children
|Risk factors for Type 2 DM:
Family history of DM
Lifestyle modification (see Management ).
Although uncertain, avoiding use of d4T, IDV may reduce risk.
Monitor for polydipsia, polyuria, polyphagia, change in body habitus, acanthosis nigricans.
Obtain RPG levels at:
Initiation of ARV therapy;
3–6 months after therapy initiation; and once a year thereafter.
For RPG ≥140 mg/dL, obtain FPG performed after 8-hour fast and consider referral to endocrinologist.
|Counsel on lifestyle modification (low-fat diet, exercise, no smoking).
Consider changing from thymidine analogue NRTI (d4T or ZDV)-containing regimen.
For either RPG ≥200 mg/dL plus symptoms of DM or FPG ≥126 mg/dL:
Patient meets diagnostic criteria for DM; consult endocrinologist.
FPG 100–125 mg/dL:
Impaired FPG is suggestive of insulin resistance; consult endocrinologist.
FPG <100 mg/dL: Normal FPG but does not exclude insulin resistance; recheck FPG in 6–12 months.