Dubé M P
Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Clin Infect Dis. 2000 Dec;31(6):1467-75. doi: 10.1086/317491. Epub 2000 Nov 29.
New-onset diabetes mellitus, clinically similar to type 2 diabetes, will affect a small proportion (1%-6%) of patients infected with human immunodeficiency virus (HIV) who are treated with HIV-1 protease inhibitors (PIs). However, insulin resistance and impaired glucose tolerance will develop during PI treatment in a considerable proportion of patients. Dyslipidemia, abdominal obesity, and loss of peripheral fat frequently coexist with insulin resistance, but it is not clear whether all of these result from a common pathogenic mechanism. Recent data suggest that insulin resistance may also be associated with HIV infection in patients not receiving PI therapy. The long-term consequences of insulin resistance in this population are not known. The effect of switching to other antiretroviral therapies has not been fully determined. Treatment of established diabetes mellitus should generally follow existing guidelines. There is no clinically useful screening test that will determine the existence and degree of insulin resistance in individual patients. It is therefore reasonable to recommend general measures to increase insulin sensitivity in all patients infected with HIV, such as weight reduction for obese persons and regular aerobic exercise.
新发性糖尿病在临床上与2型糖尿病相似，将影响一小部分（1%-6%）接受人类免疫缺陷病毒（HIV）-1蛋白酶抑制剂（PI）治疗的HIV感染患者。然而，在相当一部分患者的PI治疗期间，会出现胰岛素抵抗和糖耐量受损。血脂异常、腹部肥胖和外周脂肪减少常与胰岛素抵抗并存，但尚不清楚所有这些是否都源于共同的致病机制。最近的数据表明，在未接受PI治疗的患者中，胰岛素抵抗也可能与HIV感染有关。该人群胰岛素抵抗的长期后果尚不清楚。改用其他抗逆转录病毒疗法的效果尚未完全确定。已确诊糖尿病的治疗通常应遵循现有指南。没有临床有用的筛查试验能确定个体患者胰岛素抵抗的存在和程度。因此，建议对所有感染HIV的患者采取一般措施来提高胰岛素敏感性是合理的，如肥胖者减轻体重和定期进行有氧运动。
