Diabetes in people living with HIV

Abstract

 Antiretroviral therapy (ART) has transformed HIV infection into a chronic condition, aligning life expectancy with that of the general population. However, this has revealed a high prevalence of cardiometabolic comorbidities, particularly type 2 diabetes mellitus (T2DM).

The pathophysiology of T2DM in people living with HIV (PLWH) is multifactorial. It involves chronic low-grade inflammation, microbial translocation, and pathological adipose tissue remodeling, leading to profound insulin resistance. Furthermore, modern ART regimens based on integrase strand transfer inhibitors (INSTIs) are associated with significant weight gain and central obesity (MASLD). Facing this high cardiorenal risk phenotype, the role of novel molecules is noteworthy: GLP-1 receptor agonists (GLP-1 RAs), which promote weight loss and the reduction of major adverse cardiovascular events (MACE), and SGLT2 inhibitors (SGLT2is), which provide renal and cardiac protection without drug-drug interactions with ART.

The prognosis of PLWH currently depends on the comprehensive management of cardiometabolic risk. The early integration of GLP-1 RAs and SGLT2is is essential to mitigate morbidity and mortality and ensure healthy aging.