Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection
The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.
Management of Medication Toxicity or Intolerance
Insulin Resistance, Asymptomatic Hyperglycemia, Diabetes Mellitus
Last Updated: April 14, 2020; Last Reviewed: April 14, 2020
|Adverse Effects||Associated ARVs||Onset/Clinical Manifestations||Estimated Frequency||Risk Factors||Prevention/Monitoring||Management|
|Insulin Resistance, Asymptomatic Hyperglycemia, DMa||ZDV, LPV/r, and possibly other PIs||Onset:
||Risk Factors for Type 2 DM:
||Counsel patient on lifestyle modification (e.g., implementing a diet low in saturated fat, cholesterol, trans fat, and refined sugars; increasing physical activity; ceasing smoking). Recommend that the patient consult with a dietician.
If the patient is receiving ZDV, switch to TAF, TDF, or ABC.
For Patients with Either an RPG ≥200 mg/dL Plus Symptoms of DM or an FPG ≥126 mg/dL:
|a Insulin resistance, asymptomatic hyperglycemia, and DM form a spectrum of increasing severity.
Insulin Resistance: Often defined as elevated insulin levels for the level of glucose observed.
Impaired FPG: Often defined as an FPG of 100–125 mg/dL.
Impaired Glucose Tolerance: Often defined as an elevated 2-hour PG of 140–199 mg/dL in a 75-g OGTT (or, if the patient weighs <43 kg, 1.75 g per kg of glucose up to a maximum of 75 g).
DM: Often defined as either an FPG ≥126 mg/dL, an RPG ≥200 mg/dL in a patient with hyperglycemia symptoms, an HgbA1c of ≥6.5%, or a 2-hour PG ≥200 mg/dL in an OGTT.
However, the Panel does not recommend performing routine measurements of insulin levels, HgbA1c, or glucose tolerance without consulting an endocrinologist. These guidelines are instead based on the readily available RPG and FPG levels.
Key: ABC = abacavir; ARV = antiretroviral; BMI = body mass index; dL = deciliter; DM = diabetes mellitus; FPG = fasting plasma glucose; HgbA1c = glycosylated hemoglobin; LPV/r = lopinavir/ritonavir; OGTT = oral glucose tolerance test; the Panel = Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV; PG = plasma glucose; PI = protease inhibitor; RPG = random plasma glucose; TAF = tenofovir alafenamide; TDF = tenofovir disoproxil fumarate; ZDV = zidovudine