|Adverse Effects||Associated ARVs||Onset/Clinical Manifestations||Estimated Frequency||Risk Factors||Prevention/Monitoring||Management|
|Insulin Resistance, Asymptomatic Hyperglycemia, Diabetes Mellitus (DM)a||ZDV, LPV/r and, possibly, other PIs||Onset:
||Risk Factors for Type 2 DM:
||Counsel patient on lifestyle modification (e.g., implementing a diet low in saturated fat, cholesterol, trans fat, and refined sugars; increasing physical activity; ceasing smoking). Recommend that the patient consult with a dietician.
If the patient is receiving ZDV, switch to TAF, TDF, or ABC.
For Patients with Either an RPG ≥200 mg/dL Plus Symptoms of DM or an FPG ≥126 mg/dL:
|a Insulin resistance (IR), asymptomatic hyperglycemia, impaired fasting plasma glucose (IFPG), impaired glucose tolerance (IGT), and diabetes mellitus (DM) form a spectrum of increasing severity.
IR: Often defined as elevated insulin levels for the level of glucose observed.
IFPG: Often defined as an FPG of 100–125 mg/dL.
IGT: Often defined as an elevated 2-hour PG of 140–199 mg/dL in a 75-g OGTT (or, if the patient weighs <43 kg, 1.75 g per kg of glucose up to a maximum of
DM: Often defined as either an FPG ≥126 mg/dL, an RPG ≥200 mg/dL in a patient with hyperglycemia symptoms, an HgbA1c of ≥6.5%, or a 2-hour PG ≥200 mg/dL in an OGTT.
However, the Panel does not recommend performing routine measurements of insulin levels, HgbA1c, or glucose tolerance without consulting an endocrinologist. These guidelines are instead based on the readily available RPG and FPG levels.
Key: ABC = abacavir; ART = antiretroviral therapy; ARV = antiretroviral; BMI = body mass index; DM = diabetes mellitus; FPG = fasting plasma glucose; HgbA1c = glycosylated hemoglobin; LPV/r = lopinavir/ritonavir; mg/dL = milligrams per deciliter; OGTT = oral glucose tolerance test; the Panel = Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV; PG = plasma glucose; PI = protease inhibitor; RPG = random plasma glucose; TAF = tenofovir alafenamide; TDF = tenofovir disoproxil fumarate; ZDV = zidovudine