(Last updated: March 1, 2016; last reviewed: March 1, 2016)
|Adverse Effects||Associated ARVs||Onset/Clinical Manifestations||Estimated Frequency||Risk Factors||Prevention/ Monitoring||Management|
|Insulin Resistance, Asymptomatic Hyperglycemia, DMa||Several NRTIs (e.g., d4T, ZDV, ddI)
Several PIs (e.g., LPV/r; less often ATV, ATV/r, DRV/r, NFV, TPV/r)
ARV-Treated Adults and Children:
|Risk Factors For Type 2 DM:
||Counsel on lifestyle modification (e.g., a diet low in saturated fat, cholesterol, trans fat, and refined sugars; increased physical activity; cessation of smoking); consider consultation with dietician.
Change NRTI (e.g., from d4T, ZDV, or ddI to TDF or ABC).
For Either RPG ≥200 mg/dL Plus Symptoms of DM or FPG ≥126 mg/dL:
Normal FPG, but Does Not Exclude Insulin Resistance:
| a Insulin resistance, asymptomatic hyperglycemia, and DM form a spectrum of increasing severity. Insulin resistance is often defined as elevated insulin levels for the level of glucose observed; impaired FPG as an FPG of 100–125 mg/dL; impaired glucose tolerance as an elevated 2-hour PG of 140–199 mg/dL in a 75g-OGTT (or if <43 kg, 1.75 g/kg of glucose up to a maximum of 75g); and diabetes mellitus as either an FPG ≥126 mg/dL, a random PG ≥200 mg/dL in a patient with hyperglycemia symptoms, an HgbA1C of ≥6.5%, or a 2-hour PG after OGTT ≥200 mg/dL. However, the Panel does not recommend routine determinations of insulin levels, HgbA1C, or glucose tolerance without consultation with an endocrinologist; these guidelines are instead based on the readily available random and fasting plasma glucose levels.
Key to Acronyms: ABC = abacavir; ARV = antiretroviral; ATV = atazanavir; ATV/r = ritonavir-boosted atazanavir; BMI = body mass index; d4T = stavudine; ddI = didanosine; dL = deciliter; DM = diabetes mellitus; DRV/r = ritonavir-boosted darunavir; FPG = fasting plasma glucose; HgbA1c = glycosylated hemoglobin; LPV/r = ritonavir-boosted lopinavir; NFV = nelfinavir; NRTI = nucleoside reverse transcriptase inhibitor; OGTT = oral glucose tolerance test; PG = plasma glucose; PI = protease inhibitor; RPG = random plasma glucose; TDF = tenofovir disoproxil fumarate; TPV/r = ritonavir-boosted tipranavir; ZDV = zidovudine