Intersecting Burdens: Type 2 Diabetes Diagnosis, Risk, and Pharmacological Management Among People Living With HIV

Many patients living with human immunodeficiency virus (HIV) may develop long-term metabolic complications due to various reasons, such as chronic inflammation and adverse effects from antiretrovirals (ARVs). A particularly significant metabolic complication is type 2 diabetes (T2DM); however, limited evidence is available regarding the management of this disease state among people living with HIV (PLWH). We review the available resources and evidence on the management of T2DM among PLWH. Diagnosis and monitoring of T2DM are slightly different from the general population as hemoglobin A1c may underestimate the level of glycemia PLWH experience. Although PLWH are typically not reported within landmark clinical trials for antidiabetic medications, treatment is likely similar to those without the virus. There are several drug-drug interactions to note between ARVs and antidiabetic medications with one of the most notable being between dolutegravir and metformin. This interaction requires the maximum daily dose of metformin to be reduced. Additionally, modifications may be considered to a patient's ARV regimen in order to reduce metabolic disturbances as these medications may affect fat redistribution, lipids, weight, and insulin resistance. This review article is intended to aide clinicians in clinical decision making when treating PLWH diagnosed with T2DM.