Microvascular and macrovascular complications of diabetes in people with HIV

Diabetes mellitus (DM) is increasingly prevalent in people with HIV, with reported prevalence estimates generally ranging from 5% to 15% across contemporary cohorts. It represents a major contributor to both microvascular and macrovascular disease. People with HIV are at increased risk of insulin resistance and type 2 diabetes due to chronic immune activation, antiretroviral therapy-related metabolic effects, and traditional cardiometabolic risk factors. In this context, DM is associated with accelerated atherosclerosis, earlier onset of microvascular injury, and adverse cardiovascular outcomes. Glycaemic screening and management remain suboptimal in this population, and HbA1c may underestimate dysglycaemia in selected patients. This narrative review critically appraises current evidence on diabetes-related vascular complications in people with HIV, identifies key pathophysiological and clinical gaps, and highlights priorities for improved screening, risk stratification, and integrated management.