Question

How bad is it to have diabetes and HIV together?

21 March 2012. Related: All topics, Complications and coinfections, Living with HIV long-term, Pregnancy.

I am a 30 years old woman .I have been HIV positive since 2009 and on combination treatment. Currently my viral load is undetectable and my CD4 count is above 500.

I just had a baby girl last month. I was diagnosed with gestational diabetes while pregnant.

Now that I have the baby, I have been asked to have a glucose tolerance test done to check whether it was just during the pregnancy or if I could be at risk of diabetes.

My question is being HIV positive, how bad it is to have diabetes also? And what types of treatment will I have be put on? Basically I would just like to know quite enough about the condition, just to be prepared.

Thank you.

Answer

Answer: Rebecca McDowall

First of all congratulations on the birth of your baby girl! I hope mother and baby are doing well.

Gestational diabetes is caused when pregnancy hormones block the production of insulin in the body. This leads to increased blood sugar levels. Most women see their blood sugar levels return to normal after delivery but for others these remain high. This is why you have now been asked to take a glucose tolerance test.

Some studies have shown that HIV positive women receiving antiretroviral treatment during may be at higher risk of gestational diabetes. This is an area that requires more study however as there have been conflicting results in different studies.

Even if your glucose levels have returned to normal following delivery there is still a chance you could develop diabetes. Unfortunately many women with gestational diabetes go on to develop diabetes 5-10 years after delivery. Some studies have also shown that people with HIV may be at higher risk of developing diabetes. For this reason it is important to remain conscious of your future blood sugar levels even if your next test shows they have returned to normal.

The positive news is that because there are relatively high numbers of people living with both HIV and diabetes there is a good level understanding around treatment.

You asked what type of treatments you would be likely to be put on. Many people are able to control diabetes through lifestyle changes such as increased exercise and weight loss. Healthy eating and stopping smoking are also important for diabetes treatment. HIV positive people with diabetes should see a specialist HIV dietitian for help with dietary changes. HIV dietitians can help balance any dietary requirements to do with ARV treatment with the needs of diabetic treatment.

Some ARVs are also implicated in causing increased glucose levels. Your doctor should review which ARVs you are receiving to see if these could be affecting your diabetes. Could you tell me which ARVs you are currently receiving?

Finally if diabetes cannot be controlled through changes in lifestyle changes or ARV changes treatment with diabetic drug therapy is recommended. For more information on the drug therapies used in treating diabetes alongside HIV please follow this link.