Current antiretrovirals, hyperglycemia, and type 2 diabetes in people with HIV

People with HIV (PWH) are now effectively treated with antiretroviral therapy, including integrase strand transfer inhibitors (INSTIs) and nucleoside reverse transcriptase inhibitors (NRTIs). In the context of the global obesity epidemic, cardiometabolic complications, including type 2 diabetes, are increasingly common in PWH. In this article, we address the potential diabetogenic role of some current antiretrovirals. Beyond classical risk factors, INSTIs could promote diabetes through weight gain and drug-specific effects. They can also, rarely, induce severe acute ketosis-prone hyperglycemia. Because INSTIs and some NRTIs could alter insulin and lipid levels, standard indices of insulin resistance may be unreliable. Diabetes management generally follows recommendations for the general population, with the use of glucagon-like peptide-1 receptor agonists and sodium glucose cotransporter 2 inhibitors to reduce glycated hemoglobin A1c, weight, and cardiometabolic risk.