HIV AND ANTIRETROVIRAL THERAPY IN THE CONTEXT OF TYPE 2 DIABETES MELLITUS: A LITERATURE REVIEW

• DOI: https://doi.org/10.22533/at.ed.0159682617064

• Palavras-chave: T2DM, Human Immunodeficiency Virus, ART.

• Keywords: T2DM, Human Immunodeficiency Virus, ART.

• Abstract:

  The Human Immunodeficiency Virus (HIV), which causes AIDS, is transmitted through unprotected sexual intercourse, contaminated sharp objects, blood transfusions, and from mother to child during pregnancy, childbirth, or breastfeeding. Antiretroviral therapy (ART) reduces viral replication and has significantly decreased morbidity and mortality. However, prolonged use can cause adverse effects, such as lipodystrophic syndrome, lipid profile abnormalities, and insulin resistance, which may contribute to the development of type 2 diabetes mellitus (T2DM). In this context, the present study presents an integrative literature review on the development of T2DM in people living with HIV (PLHIV) receiving ART. The literature search in the PubMed database used the search terms “HIV” AND “Type 2 Diabetes Mellitus” AND “Antiretroviral therapy” for the period from 2023 to 2024, with full-text articles available free of charge. The database yielded 26 articles meeting these criteria, of which 8 were excluded because they were review articles. Of the remaining 18 articles, 10 were selected after individual review to form the integrative review because they met the proposed scope. The selected articles involved various types of studies conducted in different countries, highlighting adverse effects of ART, such as: hypertension (24.6%), atherosclerotic cardiovascular events (89.6%), fatty liver disease associated with metabolic dysfunction (26.6%), hepatic steatosis (46.5%), and fibrosis (9.0%). A synthesis of the information in the selected literature revealed that PLHIV on ART are at higher risk of developing type 2 diabetes (T2D), especially with prolonged use of certain medications, such as nucleoside reverse transcriptase inhibitors (NRTIs—stavudine, zidovudine) and protease inhibitors (PIs, indinavir). The long duration of living with HIV, combined with persistent levels of inflammation, oxidative stress, and medication-induced mitochondrial damage, contributes to a risk approximately four times higher for developing DM in PLHIV on ART (NRTI and PI, especially when combined). Given that risk factors for type 2 diabetes (T2D) include age, overweight, diet, socioeconomic status, chronic inflammation, and medication use, appropriate management of metabolic risk in patients on ART should involve a multifactorial approach, including regular clinical monitoring, therapeutic adjustments, and lifestyle changes.