NUTRITION (K SCHLOSSER MONTES, SECTION EDITOR)
Glycemic Control in HIV Patients
Published online: 10 July 2017
Springer International Publishing AG 2017
Purpose of Review Glycemic alterations are highly prevalent
in HIV-infected and non-HIV-infected patients. Our purpose
was to review the etiology, diagnosis, and management of
dysglycemia to improve the treatment in the HIV population.
Recent Findings Fourteen percent of HIV patients have dia-
betes. Etiology factors can be divided in environmental factors
(weight, age, smoking), as well as factors merely associated to
HIV, such as viral effects, growth hormone deficiency, antire-
troviral therapy, lipodystrophy, hepatic steatosis, and hepatitis
C co-infection. Diabetes diagnosis is comparable to those un-
infected, being the only exception the glycosylated hemoglo-
bin criteria. However, treatment differs due to drug interac-
tions between oral antidiabetic drugs and antiretrovirals.
Lifestyle modifications in diet and exercise remain essential
as a complement to the pharmacological treatment.
Summary We reviewed current information about epidemiol-
ogy, etiology, diagnosis, and management of glycemic alter-
ations in HIV-infected patients.
Diabetes mellitus (DM) is becoming more common. From
1980 through 2014, the number of Americans with the dis-
ease, increased fourfold, from 5.5 million to 22.0 million .
Human immunodeficiency virus (HIV), on the other hand,
decreased its prevalence, dropping 19% of new diagnoses
from 2005 to 2014 . Nevertheless, DM prevalence esti-
mates in HIV-infected patients is up to 14% [3••]. This in-
creased number of unexpected consequences of chronic ill-
ness has been seen since the introduction of highly active
antiretroviral therapy (HAART) [4••].
The mechanisms underlying dysglycemia and the relation-
ship of the glucose metabolic disorders to those of lipid me-
tabolism and fat redistribution, ethnicity, diet, and specific
HAART agents are multifaceted, complex and, to some de-
gree, enigmatic [4••].
Lipodystrophy syndrome or HIV metabolic syndrome is
characterized by alterations in the lipid and glucose metabo-
lism, excess and redistribution of body fat, and hypertension.
Despite the HAART bringing many benefits to carriers of the
HIV, metabolic changes can occur as side effects, increasing
cardiovascular risks and insulin resistance (IR) .
Our goal is to review key issues in the development of
dysglycemia in HIV-infected patients in order to prevent, di-
agnose, and treat correctly those alterations with lifestyle
modifications and considering drug interactions between oral
anti diabetic drugs (OADs) and HAART.
The risk of DM in HIV-infected patients has been through an
ongoing scrutiny probably due to the fact that three subgroups
of patients with diabetes and HIV can be identified: patients
Topical Collection on Nutrition
* Geovani Palma
Division of Internal Medicine, Hospital General San Juan de Dios, 1
Ave. 10-50, Z. 1, Guatemala, Guatemala
School of Clinical Nutrition, Universidad Francisco Marroquín,
Curr Trop Med Rep (2017) 4:166–171