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Insulin Resistance in HIV

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Insulin Resistance in HIV, HIV Related Metabolic Syndrome

  • See Also
  1. Cardiovascular Manifestations of HIV
  2. Metabolic Syndrome
  3. Type 2 Diabetes Mellitus
  4. HIV Complications
  • Pathophysiology
  1. Insulin Resistance effects in HIV are independent of BMI and age
    1. Associated with chronic inflammation and immune activation (regardless of ART)
    2. Increased pro-inflammatory Cytokines (cRP, TNF-a, IL-1B)
    3. Impaired Insulin signaling
  2. ART medications also increase Insulin Resistance via impaired beta function and Lipodystrophy
    1. Protease Inhibitors
    2. Older, thymidine nRTI (e.g. AZT, d4T)
  • Management
  1. See Cardiovascular Manifestations of HIV
  2. See Metabolic Syndrome
  3. See Hyperlipidemia Management
  4. Lifestyle modifications (weight loss, Exercise, Healthy Diet)
  5. Consider Metformin, GLP1 Agonists
  6. Follow lipid panel (at HIV diagnosis, 2-8 weeks after starting ART, then at least annually)
  7. Follow Serum Glucose at baseline, 3-6 months after modifying ART and at least annually
    1. Glucose-based monitoring is preferred
    2. Hemoglobin A1C is less reliable in HIV due to altered Red Blood Cell turnover
  • References
  1. Jaqua (2026) Am Fam Physician 113(1): 71-9 [PubMed]