Table 8.

Management of diabetes in patients with HIV

Adapted from [137]

Strategies	Management
General management	Treatment for comorbid conditions   Hypertension—treatment with ACE inhibitors and ARBs not an optimal choice in patients with HIV   Dyslipidemia—treatment with pravastatin, fluvastatin, atorvastatin, and rosuvastatin in patients with HIV
Non-insulin therapies	Use metformin if well tolerated and if no contraindications are present Use SU/alpha-glucosidase inhibitors if metformin is contraindicated/not tolerated. Thiazolidinediones and DPP-4 inhibitors are also used in patients with HIV Use incretin mimetics if weight loss is desired
Insulin	Initiate basal-bolus regimen or premixed insulin (1.0 U/kg/day) at diagnosis Insulin may be tapered or reduced (0.5 U/kg/day) once control is achieved Initiate insulin aspart in patients with ketonuria and for critically ill patients Educate HIV-infected patients on how to dispose of lancets, glucose strips, insulin syringes, pens, and needles to prevent HIV transmission
Changes in HAART	Pre-existing T2DM may continue to be managed after diagnosis of HIV by continuing with the same drug therapy that was being used prior to detection of HIV Patients diagnosed with diabetes and HIV together may be treated with metformin if well tolerated and if no contraindications are present. Depending on the baseline HbA1c, insulin or low dose meglitinides can be initiated as a second-line therapy Patients developing diabetes after HAART may be treated with metformin or other OADs. Insulin is a better and safer choice and may be tapered or reduced once control is achieved

ACE angiotensin converting enzyme, ARB angiotensin receptor blockers, HIV human immunodeficiency virus, HCW health care worker, SU sulfonylurea, DPP-4 inhibitors dipeptidyl peptidase-4 inhibitors, HAART highly active antiretroviral therapy