Glucose disorders associated with HIV and its drug therapy. The annals of pharmacotherapy

Metabolic and endocrine abnormalities have been notedin patients infected with HIV, whether they were or were not taking antiretroviral therapy.1-4 These abnormali-ties include, but are not limited to, lipid and glucose home-ostasis abnormalities and gonadal dysfunction. Most inves-tigations preceding the institution of potent antiretroviral therapy focused on the AIDS-associated wasting syn-drome and its relationship to altered metabolism, as it rep-resented an identifying characteristic of advancing HIV in-fection.5,6 The introduction of potent antiretroviral therapy enabled clinicians to treat HIV-infected patients with drug regimens capable of decreasing viral burden below the level of assay quantification, enabling them to live longer, more productive lives.7-9 However, as we progress into the era of HIV as a chronic disease, additional clinical complications such as diabetes mellitus and changes in fat distribution have appeared.10 The pathogenesis of these abnormalities is unknown and, although a direct effect of potent an-tiretroviral therapy is suspected, a primary metabolic effect secondary to HIV infection, but which is intensified by an-tiretroviral therapy, remains under evaluation. This article illustrates how alterations in glucose metab-olism fit into the spectrum of metabolic abnormalities en-countered in HIV-infected patients receiving, as well as those not receiving, potent antiretroviral therapy. To do so, pertinent information was derived from a review of the En-glish-language medical literature with regard to the metab-olic abnormalities associated with the lipodystrophy syn-drome. This article also provides the reader with recom-mendations for the clinical management of hyperglycemia/ diabetes mellitus in HIV-infected patients undergoing po-tent antiretroviral therapy