Can HIV Worsen Diabetes?

The Black community accounted for 37% of estimated new HIV infections in the United States, despite representing only 12% of the population population, according to 2022 data from the Centers for Disease Control (CDC). Several factors contribute to this disproportionate burden in our community, including outdated HIV criminalization laws and systemic inequities in healthcare access and education.

One condition that is common among people living with HIV is type 2 diabetes. In 2024, Black adults received 24% diabetes diagnosis more frequently than adults of all other ethnic groups. Government data also show that Black adults have the highest mortality rate from diabetes-related complications compared to any other ethnicity in the United States. A 2017 research data suggests that the prevalence of diabetes mellitus is 3.8% higher in adults living with HIV.

People living with HIV are particularly advised to learn about the symptoms of diabetes, which may include frequent urination, increased thirst, excessive hunger, fatigue, unexplained weight loss, blurred vision, and tingling or numbness in the feet or hands. Inflammation serves as a biological link between the two conditions.

The Relationship Between HIV and Inflammation

HIV is a virus that hijacks the host cells and uses their machinery to make more copies of the virus, instead of normal host cells. This uncontrolled replication of the virus will lead to the activation of immune cells to fight the virus.

One of the ways immune cells will try to fight the virus is by releasing materials that cause inflammation in the area surrounding the virus. The rapid replication of the virus triggers a constant state of immune activation, leading to chronic inflammation. This can lead to organ damage and increase the risk for several health conditions, including:

Chronic obstructive pulmonary disease (COPD)
Cancer
Cardiovascular disease
Diabetes
Kidney disease

How Chronic Inflammation Can Lead to Diabetes

Diabetes occurs when the blood glucose levels become too high, leading to damage in blood vessels and nerves. The pancreas is supposed to produce hormones, such as glucagon and insulin, to regulate the level of glucose in the blood. The presence of insulin tells the body to absorb glucose for energy.

Chronic inflammation contributes to insulin resistance, where the body cells become less sensitive to insulin signals. Certain medications, like some of those used to treat individuals with HIV, can interfere with the normal functioning of insulin. Some of the ways HIV medication may increase the risk of diabetes include:

Immune Reconstitution Inflammatory Syndrome (IRIS): HIV medication can improve the recovery of the immune system. Upon recovery, they may produce exaggerated inflammatory responses to the remaining virus particles and other infections. This long-term immune activation worsens blood sugar regulation
Metabolic effect: Protease inhibitors (ritonavir) and nucleoside reverse-transcriptase inhibitors (abacavir) have both been associated with increased bad cholesterol levels and visceral fat, which can raise the risk of diabetes
Insulin resistance: Older protease inhibitor HIV medications directly interfere with insulin signaling at the cellular level or through toxic effects that creates lipid metabolism issues, which can increase the risk of type 2 diabetes

Lowering Diabetes Risk Among People Living With HIV

Adults with HIV in our communities are encouraged to monitor their blood sugar levels regularly. While medication is important, people living with HIV should also consider a supplemental holistic approach for diabetes rather than relying exclusively on HIV medication. A holistic approach for diabetes prevention and management in mind should include the following;

1. Diet modification

A healthy diet will help to maintain healthy blood sugar levels. People living with HIV should lower their intake of salt, refined sugars, carbohydrates, and unhealthy fats. They should opt for lean protein like fish and chicken instead of red meat. The goal should be to incorporate anti-inflammatory nutrition in their daily diet and drink lots of water instead of sugary beverages.

2. Lifestyle change

A sedentary lifestyle increases the risk of type 2 diabetes. People living with HIV should get regular exercise because it improves insulin sensitivity and helps with weight management. Black adults living with HIV should aim for a minimum of 150 minutes of moderate exercise weekly. This can include dancing, brisk walking, or cycling. Smoking can also significantly increase the risk of developing health problems associated with diabetes or make it harder to manage the condition.

3. Supporting medication

If you have been diagnosed with prediabetes, it is important to discuss with your physician to see if you qualify for prediabetes treatment, in addition to lifestyle changes. Supporting medications can also be used to treat co-infections that raise the patient’s diabetes risk.

Optimal care for people living with HIV and diabetes should not be managed alone. It requires collaboration of a team of specialists, along with loved ones providing moral and emotional support. The team of specialists should check your HIV medication for drug interactions and possible allergic reactions or side effects that may increase the risk of diabetes. This should help them develop a personalized treatment plan tailored to your needs.

Managing HIV and the risk of diabetes can significantly raise your stress level. If this mental stress is not properly managed, it creates room for other health challenges, including anxiety and depression, which would worsen your condition. Therefore, it helps to find a support network that will help you emotionally to go through the uncertainties of HIV treatment. This network can include close family members, friends, a trusted counselor, or a Black community of adults living with HIV.

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