Glucose disorders associated with HIV and its drug therapy

OBJECTIVE: TO review the impact that factors such as HIV infection, antiret rovirals, and other commonly used drug therapies have on glucose metabolism in HIV-infected patients. DATA SOURCES: Pertinent literature was identified via a MEDLINE search from 1980 to April 2000 and through secondary sources (abstracts presented at r ecent scientific meetings, manufacturers' package inserts). The key words u sed were antiretroviral therapy, HIV infection, insulin resistance, and met abolic abnormalities. All information deemed relevant to evaluate the impac t that HIV infection and drug therapy have on glucose metabolism in HIV-inf ected patients was included. DATA SYNTHESIS: The viral burden and stress that are present in HIV-infecte d patients elicit a complex hormonal and immunologic response that may alte r various biochemical pathways, including glucose metabolism. Although rare before the era of potent antiretroviral therapy, insulin resistance has no w been described as an important component of the lipodystrophy syndrome. T he complex and multifactorial nature of glucose metabolism dysregulation ma kes management of hyperglycemia or diabetes mellitus challenging in HIV-inf ected patients. In such a context, a set of recommendations was developed t o guide practitioners in assessing, treating, and monitoring hyperglycemia or diabetes mellitus in HIV-infected patients. CONCLUSIONS: Alterations of glucose metabolism observed in HIV-infected pat ients are more frequent since the introduction of potent antiretroviral the rapy. Although the etiology of such abnormalities remains unknown,:protease inhibitors and, to a lesser extent, nucleoside reverse transcriptase inhib itors are believed to participate in their pathogenic mechanisms. Because o f similarities to the pathogenesis of diabetes mellitus, management of anti retroviral-induced hyperglycemia could follow that the recommendations of t he American Diabetes Association, with special considerations for monitorin g patients with HIV infection. Future studies of altered glucose metabolism in HIV-infected:patients should focus on understanding the precise mechani sm or causes of this complication so that preventive and therapeutic guidel ines can be further evaluated.