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.

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Management of Medication Toxicity or Intolerance

Insulin Resistance, Asymptomatic Hyperglycemia, Diabetes Mellitus

Last Updated: April 14, 2020; Last Reviewed: April 14, 2020


  1. Aldrovandi GM, Lindsey JC, Jacobson DL, et al. Morphologic and metabolic abnormalities in vertically HIV-infected children and youth. AIDS. 2009;23(6):661-672. Available at:
  2. American Diabetes Association. Classification and diagnosis of diabetes. Diabetes Care. 2016;39 Suppl 1:S13-22. Available at:
  3. Chantry CJ, Hughes MD, Alvero C, et al. Lipid and glucose alterations in HIV-infected children beginning or changing antiretroviral therapy. Pediatrics. 2008;122(1):e129-138. Available at:
  4. Dirajlal-Fargo S, Musiime V, Cook A, et al. Insulin resistance and markers of inflammation in HIV-infected Ugandan children in the CHAPAS-3 Trial. Pediatr Infect Dis J. 2017;36(8):761-767. Available at:
  5. Espiau M, Yeste D, Noguera-Julian A, et al. Metabolic syndrome in children and adolescents living with HIV. Pediatr Infect Dis J. 2016;35(6):e171-176. Available at:
  6. Fortuny C, Deya-Martinez A, Chiappini E, Galli L, de Martino M, Noguera-Julian A. Metabolic and renal adverse effects of antiretroviral therapy in HIV-infected children and adolescents. Pediatr Infect Dis J. 2015;34(5 Suppl 1):S36-43. Available at:
  7. Geffner ME, Patel K, Miller TL, et al. Factors associated with insulin resistance among children and adolescents perinatally infected with HIV-1 in the pediatric HIV/AIDS cohort study. Horm Res Paediatr. 2011;76(6):386-391. Available at:
  8. Hadigan C, Kattakuzhy S. Diabetes mellitus type 2 and abnormal glucose metabolism in the setting of human immunodeficiency virus. Endocrinol Metab Clin North Am. 2014;43(3):685-696. Available at:
  9. Hazra R, Hance LF, Monteiro JP, et al. Insulin resistance and glucose and lipid concentrations in a cohort of perinatally HIV-infected Latin American children. Pediatr Infect Dis J. 2013;32(7):757-759. Available at:
  10. Innes S, Abdullah KL, Haubrich R, Cotton MF, Browne SH. High prevalence of dyslipidemia and insulin resistance in HIV-infected pre-pubertal African children on antiretroviral therapy. Pediatr Infect Dis J. 2016;35(1):e1-7. Available at:
  11. Loomba-Albrecht LA, Bregman T, Chantry CJ. Endocrinopathies in children infected with human immunodeficiency virus. Endocrinol Metab Clin North Am. 2014;43(3):807-828. Available at:
  12. Mirani G, Williams PL, Chernoff M, et al. Changing trends in complications and mortality rates among US youth and young adults with HIV infection in the era of combination antiretroviral therapy. Clin Infect Dis. 2015;61(12):1850-1861. Available at:
  13. Non LR, Escota GV, Powderly WG. HIV and its relationship to insulin resistance and lipid abnormalities. Transl Res. 2017;183:41-56. Available at:
  14. Paganella MP, Cohen RA, Harris DR, et al. Association of dyslipidemia and glucose abnormalities with antiretroviral treatment in a cohort of HIV-infected Latin American children. J Acquir Immune Defic Syndr. 2017;74(1):e1-e8. Available at:
  15. Patel K, Wang J, Jacobson DL, et al. Aggregate risk of cardiovascular disease among adolescents perinatally infected with the human immunodeficiency virus. Circulation. 2014;129(11):1204-1212. Available at:
  16. Samaras K. Prevalence and pathogenesis of diabetes mellitus in HIV-1 infection treated with combined antiretroviral therapy. J Acquir Immune Defic Syndr. 2009;50(5):499-505. Available at:
  17. Takemoto JK, Miller TL, Wang J, et al. Insulin resistance in HIV-infected youth is associated with decreased mitochondrial respiration. AIDS. 2017;31(1):15-23. Available at:
  18. Geffner ME, Patel K, Jacobson DL, et al. Changes in insulin sensitivity over time and associated factors in HIV-infected adolescents. AIDS. 2018;32(5):613-622. Available at:

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