In the UK, about 3 million people are living with diabetes, and many more are expected to develop diabetes in the near future. This compares with about 100,000 (0.1 million) people living with HIV (PLWH). The main risk factors for diabetes (type 2) are well-known, and apply to PLWH as well as the general population – having a close family member with diabetes; being overweight; lack of exercise; being older; having high cholesterol; having high blood pressure. But for PLWH, there are other factors that lead to an increased risk. These include having taken certain HIV drugs in the past (for example, d4T, ddI, AZT – these are older drugs, no longer commonly used in the UK today); having had a low CD4 count; having had lipodystrophy; taking boosted protease inhibitors (PIs). And just having HIV itself is an increased risk factor, due to the ongoing inflammation caused by HIV, even at non-detectable levels of virus in the blood.
You should be being monitored for blood sugar (diabetes). If this becomes elevated and is not controlled by the usual means (diet and exercise), and you are taking PIs, you may need to consider a switch in HIV treatment regimen, though the other means of controlling blood sugar are probably going to be more effective, and switching ARVs should be seen as part of an overall glucose reduction programme, and would not in itself solve the problem.
Treatment for diabetes in PLWH can also be more complex. There may be drug interactions between the diabetes drugs and HIV drugs. This will need to be checked carefully by your clinicians.