Case of the Month: Diabetes and ARV Selection

Case Summary

A doctor asked about a 48-year-old African-American male who had been diagnosed with HIV in 2001. The patient is currently taking an abacavir/lamivudine combo pill, tenofovir, atazanavir, and ritonavir. The patient’s mutations included M184V and KI103N. The patient’s CD4 count was 560, with an undetectable viral load. The patient had recently been diagnosed with diabetes mellitus and has a family history of diabetes. An HbA1c test result taken one week before the call was 6.5 (a previous test result had been 6.7). The patient had no other co-morbidities or lab abnormalities. The caller asked if it was worthwhile to change atazanavir to darunavir in order to reduce blood sugar levels/risk of diabetes?

CCC Consultant Advice

Atazanavir and darunavir are both generally considered lower risk for glucose intolerance. There is no clear data showing that changing from atazanavir to darunavir improves glucose intolerance. Changing HAART at this point may not be helpful for the patient’s glucose intolerance, and in case drug resistance develops later, it may be beneficial to have darunavir as an option for a future regimen. The consultant advised the caller to consider continuing the current drug regimen. The consultant also suggested that the caller should encourage his patient to continue to pursue lifestyle changes, and to continue ongoing monitoring and medically treat as needed.

Because CCC consultations are based on information provided by the caller or clinician accessing the online consultation center, without the benefit of a direct evaluation or examination of the patient, consultations are intended to be used as a guide. They do not constitute medical advice and are not to serve as a substitute for medical judgment. This Case of the Month includes consultation based on the most up-to-date evidence at the time of its publication. To learn about current recommendations, please call one of our clinical consultation lines.