Skip to main content

Advertisement

Log in

Diabetes, insulin resistance, and HIV

  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

The transformation of HIV infection into a chronically managed illness through the widespread use of highly active antiretroviral therapy has brought with it comorbid conditions such as increased risk of cardiovascular disease. Diabetes and insulin resistance have emerged as important comorbidities associated with HIV infection and the use of antiretroviral therapy. Significant inroads have been made towards understanding the etiology of insulin resistance and diabetes in association with HIV and highly active antiretroviral therapy, and there are also emerging data on the prevalence and incidence of this problem. The recognition and management of diabetes mellitus, insulin resistance, and related complications will be an important part of long-term health maintenance for HIV-infected patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Hadigan C, Meigs JB, Corcoran C, et al.: Metabolic abnormalities and cardiovascular disease risk factors in adults with human immunodeficiency virus infection and lipodystrophy. Clin Infect Dis 2001, 32:130–139.

    Article  PubMed  CAS  Google Scholar 

  2. Brown TT, Cole SR, Li X, et al.: Antiretroviral therapy and the prevalence and incidence of diabetes mellitus in the multicenter AIDS cohort study. Arch Intern Med 2005, 165:1179–1184. This large cohort study provides useful data on the prevalence and incidence of type 2 diabetes in men with HIV infection compared with a well-matched control population.

    Article  PubMed  Google Scholar 

  3. Justman JE, Benning L, Danoff A, et al.: Protease inhibitor use and the incidence of diabetes mellitus in a large cohort of HIV-infected women. J Acquir Immune Defic Syndr 2003, 32:298–302.

    Article  PubMed  CAS  Google Scholar 

  4. Friis-Moller N, Sabin CA, Weber R, et al.: Combination antiretroviral therapy and the risk of myocardial infarction. N Engl J Med 2003, 349:1993–2003. In this large, multinational, prospective cohort study, not only was cardiovascular disease identified in association with increased exposure to HAART, but diabetes was identified as an independent risk factor associated with cardiovascular disease in the population with HIV infection.

    Article  PubMed  Google Scholar 

  5. Hadigan C, Miller K, Corcoran C, et al.: Fasting hyperinsulinemia and changes in regional body composition in human immunodeficiency virus-infected women. J Clin Endocrinol Metab 1999, 84:1932–1937.

    Article  PubMed  CAS  Google Scholar 

  6. Hadigan C, Corcoran C, Stanley T, et al.: Fasting hyperinsulinemia in human immunodeficiency virus-infected men: relationship to body composition, gonadal function, and protease inhibitor use. J Clin Endocrinol Metab 2000, 85:35–41.

    Article  PubMed  CAS  Google Scholar 

  7. Walli R, Herfort O, Michl GM, et al.: Treatment with protease inhibitors associated with peripheral insulin resistance and impaired oral glucose tolerance in HIV-1-infected patients. AIDS 1998, 12:F167–173.

    Article  PubMed  CAS  Google Scholar 

  8. Carr A, Samaras K, Thorisdottir A, et al.: Diagnosis, prediction, and natural course of HIV-1 protease-inhibitor-associated lipodystrophy, hyperlipidaemia, and diabetes mellitus: a cohort study. Lancet 1999, 353:2093–2099.

    Article  PubMed  CAS  Google Scholar 

  9. Howard AA, Floris-Moore M, Arnsten JH, et al.: Disorders of glucose metabolism among HIV-infected women. Clin Infect Dis 2005, 40:1492–1499.

    Article  PubMed  CAS  Google Scholar 

  10. Danoff A, Shi Q, Justman J, et al.: Oral glucose tolerance and insulin sensitivity are unaffected by HIV infection or antiretroviral therapy in overweight women. J Acquir Immune Defic Syndr 2005, 39:55–62.

    Article  PubMed  Google Scholar 

  11. Bitnun A, Sochett E, Dick PT, et al.: Insulin sensitivity and beta-cell function in protease inhibitor-treated and -naive human immunodeficiency virus-infected children. J Clin Endocrinol Metab 2005, 90:168–174.

    Article  PubMed  CAS  Google Scholar 

  12. Beregszaszi M, Dollfus C, Levine M, et al.: Longitudinal evaluation and risk factors of lipodystrophy and associated metabolic changes in HIV-infected children. J Acquir Immune Defic Syndr 2005, 40:161–168.

    Article  PubMed  CAS  Google Scholar 

  13. Mehta SH, Brancati FL, Sulkowski MS, et al.: Prevalence of type 2 diabetes mellitus among persons with hepatitis C virus infection in the United States. Ann Intern Med 2000, 133:592–599.

    PubMed  CAS  Google Scholar 

  14. Visnegarwala F, Chen L, Raghavan S, Tedaldi E: Prevalence of diabetes mellitus and dyslipidemia among antiretroviral naive patients co-infected with hepatitis C virus (HCV) and HIV-1 compared to patients without co-infection. J Infect 2005, 50:331–337.

    Article  PubMed  Google Scholar 

  15. Mynarcik DC, McNurlan MA, Steigbigel RT, et al.: Association of severe insulin resistance with both loss of limb fat and elevated serum tumor necrosis factor receptor levels in HIV lipodystrophy. J Acquir Immune Defic Syndr 2000, 25:312–321.

    Article  PubMed  CAS  Google Scholar 

  16. Mallal SA, John M, Moore CB, et al.: Contribution of nucleoside analogue reverse transcriptase inhibitors to subcutaneous fat wasting in patients with HIV infection. AIDS 2000, 14:1309–1316.

    Article  PubMed  CAS  Google Scholar 

  17. Brown TT, Li X, Cole SR, et al.: Cumulative exposure to nucleoside analogue reverse transcriptase inhibitors is associated with insulin resistance markers in the Multicenter AIDS Cohort Study. AIDS 2005, 19:1375–1383.

    Article  PubMed  CAS  Google Scholar 

  18. Meininger G, Hadigan C, Rietschel P, Grinspoon S: Bodycomposition measurements as predictors of glucose and insulin abnormalities in HIV-positive men. Am J Clin Nutr 2002, 76:460–465.

    PubMed  CAS  Google Scholar 

  19. Kosmiski LA, Kuritzkes DR, Lichtenstein KA, et al.: Fat distribution and metabolic changes are strongly correlated and energy expenditure is increased in the HIV lipodystrophy syndrome. AIDS 2001, 15:1993–2000.

    Article  PubMed  CAS  Google Scholar 

  20. Hadigan C, Kamin D, Liebau J, et al.: Depot specific regulation of glucose uptake and insulin sensitivity in HIV-lipodystrophy. Am J Physiol Endocrinol Metab 2005, Epublished August 30, 2005.

  21. Lagathu C, Bastard JP, Auclair M, et al.: Antiretroviral drugs with adverse effects on adipocyte lipid metabolism and survival alter the expression and secretion of proinflammatory cytokines and adiponectin in vitro. Antivir Ther 2004, 9:911–920.

    PubMed  Google Scholar 

  22. Murata H, Hruz PW, Mueckler M: The mechanism of insulin resistance caused by HIV protease inhibitor therapy. J Biol Chem 2000, 275:20251–20254.

    Article  PubMed  CAS  Google Scholar 

  23. Noor MA, Lo JC, Mulligan K, et al.: Metabolic effects of indinavir in healthy HIV-seronegative men. AIDS 2001, 15:F11–18.

    Article  PubMed  CAS  Google Scholar 

  24. Noor MA, Seneviratne T, Aweeka FT, et al.: Indinavir acutely inhibits insulin-stimulated glucose disposal in humans: a randomized, placebo-controlled study. AIDS 2002, 16:F1–8.

    Article  PubMed  Google Scholar 

  25. Noor MA, Parker RA, O’Mara E, et al.: The effects of HIV protease inhibitors atazanavir and lopinavir/ritonavir on insulin sensitivity in HIV-seronegative healthy adults. AIDS 2004, 18:2137–2144.

    Article  PubMed  CAS  Google Scholar 

  26. Petersen KF, Dufour S, Befroy D, et al.: Reversal of nonalcoholic hepatic steatosis, hepatic insulin resistance, and hyperglycemia by moderate weight reduction in patients with type 2 diabetes. Diabetes 2005, 54:603–608.

    Article  PubMed  CAS  Google Scholar 

  27. Hadigan C, Borgonha S, Rabe J, et al.: Increased rates of lipolysis among HIV-infected men receiving highly active antiretroviral therapy. Metabolism 2002, 51:1143–1147.

    Article  PubMed  CAS  Google Scholar 

  28. Sekhar RV, Jahoor F, White AC, et al.: Metabolic basis of HIV-lipodystrophy syndrome. Am J Physiol Endocrinol Metab 2002, 283:E332–337.

    PubMed  CAS  Google Scholar 

  29. Gan SK, Samaras K, Thompson CH, et al.: Altered myocellular and abdominal fat partitioning predict disturbance in insulin action in HIV protease inhibitor-related lipodystrophy. Diabetes 2002, 51:3163–3169.

    Article  PubMed  CAS  Google Scholar 

  30. Reeds DN, Yarasheski KE, Fontana L, et al.: Alterations in liver, muscle, and adipose tissue insulin sensitivity in men with HIV infection and dyslipidemia. Am J Physiol Endocrinol Metab 2005, Epublished August_23, 2005.

  31. Hadigan C, Rabe J, Meininger G, et al.: Inhibition of lipolysis improves insulin sensitivity in protease inhibitor-treated HIV-infected men with fat redistribution. Am J Clin Nutr 2003, 77:490–494.

    PubMed  CAS  Google Scholar 

  32. Saint-Marc T, Touraine JL: Effects of metformin on insulin resistance and central adiposity in patients receiving effective protease inhibitor therapy. AIDS 1999, 13:1000–1002.

    Article  PubMed  CAS  Google Scholar 

  33. Tomazic J, Karner P, Vidmar L, et al.: Effect of metformin and rosiglitazone on lipid metabolism in HIV infected patients receiving protease inhibitor containing HAART. Acta Dermatovenerol Alp Panonica Adriat 2005, 14:99–105.

    PubMed  Google Scholar 

  34. Hadigan C, Corcoran C, Basgoz N, et al.: Metformin in the treatment of HIV lipodystrophy syndrome: A randomized controlled trial. JAMA 2000, 284:472–477.

    Article  PubMed  CAS  Google Scholar 

  35. Hadigan C, Yawetz S, Thomas A, et al.: Metabolic effects of rosiglitazone in HIV lipodystrophy: A randomized controlled trial. Ann Intern Med 2004, 140:786–794.

    PubMed  CAS  Google Scholar 

  36. van Wijk JP, de Koning EJ, Cabezas MC, et al.: Comparison of rosiglitazone and metformin for treating HIV lipodystrophy: a randomized trial. Ann Intern Med 2005, 143:337–346.

    PubMed  Google Scholar 

  37. Carr A, Workman C, Carey D, et al.: No effect of rosiglitazone for treatment of HIV-1 lipoatrophy: randomized, double-blind, placebo-controlled trial. Lancet 2004, 363:429–438.

    Article  PubMed  CAS  Google Scholar 

  38. Sutinen J, Hakkinen AM, Westerbacka J, et al.: Rosiglitazone in the treatment of HAART-associated lipodystrophy—a randomized double-blind placebo-controlled study. Antivir Ther 2003, 8:199–207.

    PubMed  CAS  Google Scholar 

  39. Tebas P, Yarasheski K, Henry K, et al.: Evaluation of the virological and metabolic effects of switching protease inhibitor combination antiretroviral therapy to nevirapine-based therapy for the treatment of HIV infection. AIDS Res Hum Retroviruses 2004, 20:589–594.

    Article  PubMed  CAS  Google Scholar 

  40. Carr A, Workman C, Smith DE, et al.: Abacavir substitution for nucleoside analogs in patients with HIV lipoatrophy: a randomized trial. JAMA 2002, 288:207–215.

    Article  PubMed  CAS  Google Scholar 

  41. Gavrila A, Tsiodras S, Doweiko J, et al.: Exercise and vitamin E intake are independently associated with metabolic abnormalities in human immunodeficiency virus-positive subjects: a cross-sectional study. Clin Infect Dis 2003, 36:1593–1601.

    Article  PubMed  Google Scholar 

  42. Yarasheski KE, Tebas P, Stanerson B, et al.: Resistance exercise training reduces hypertriglyceridemia in HIVinfected men treated with antiviral therapy. J Appl Physiol 2001, 90:133–138.

    PubMed  CAS  Google Scholar 

  43. Driscoll SD, Meininger GE, Lareau MT, et al.: Effects of exercise training and metformin on body composition and cardiovascular indices in HIV infected patients. AIDS 2004, 18:465–473.

    Article  PubMed  CAS  Google Scholar 

  44. Martinez E, Domingo P, Ribera E, et al.: Effects of metformin or gemfibrozil on the lipodystrophy of HIV-infected patients receiving protease inhibitors. Antiviral Therapy 2003, 8:403–410.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Colleen Hadigan MD, MPH.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hadigan, C. Diabetes, insulin resistance, and HIV. Curr Infect Dis Rep 8, 69–75 (2006). https://doi.org/10.1007/s11908-006-0037-1

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11908-006-0037-1

Keywords

Navigation