II. Pathophysiology
- Insulin Resistance effects in HIV are independent of BMI and age
- ART medications also increase Insulin Resistance via impaired beta function and Lipodystrophy
- Protease Inhibitors
- Older, thymidine nRTI (e.g. AZT, d4T)
III. Management
- See Cardiovascular Manifestations of HIV
- See Metabolic Syndrome
- See Hyperlipidemia Management
- Lifestyle modifications (weight loss, Exercise, Healthy Diet)
- Consider Metformin, GLP1 Agonists
- Follow lipid panel (at HIV diagnosis, 2-8 weeks after starting ART, then at least annually)
- Follow Serum Glucose at baseline, 3-6 months after modifying ART and at least annually
- Glucose-based monitoring is preferred
- Hemoglobin A1C is less reliable in HIV due to altered Red Blood Cell turnover