How sweet it is? Susceptibility to diabetes mellitus in HIV-1 treatment

Treatment of HIV-1 infection with combined antiretroviral therapy substantially improves survival and quality of life, but is associated with metabolic disturbances such as insulin resistance, dyslipidemia and body fat partitioning disorders. These metabolic complications in the setting of suppression of viral replication are associated with increased observed risk for Type 2 diabetes mellitus. Disorders of glucose metabolism present additional challenges in the management of HIV infection, including the long-term complications of hyperglycemia, such as nephropathy, neuropathy and retinopathy, and magnified cardiovascular risk. This article considers how HIV infection and its treatment increases susceptibility to disorders of glucose metabolism. Diagnostic criteria, historical and clinical antecedents that assist the clinician in detection of diabetes susceptibility and treatment objectives are discussed.