HIV-1 infection, diabetes mellitus, and psychiatric disorders

Adult-onset (type 2) diabetes mellitus (DM) has become an increasing concern in the field of HIV/AIDS since the introduction of highly active antiretroviral therapy (HAART), now referred to as combination antiretroviral therapy (CART), in 1996. The increased incidence of DM has occurred as a long-term toxic side effect of the use of two classes of antiretroviral (ARV) agents – the protease inhibitors (PIs) and the nucleoside reverse transcriptase inhibitors (nRTIs), predominantly the former. However, it is also thought that the prevalence of metabolic syndrome (characterized by central obesity, dyslipidemia, hypertension, and insulin resistance) associated with DM outside of HIV-1 infection increases in prevalence in the setting of HIV-1 infection. We will examine in this chapter how the risks for DM in the general population interact with those in HIV-1-infected individuals to produce a higher risk for DM and its associated complications of coronary artery disease (CAD), myocardial infarction (MI), and cerebrovascular accident (CVA). We will then examine how neuropsychiatric disorders and treatments common in HIV-1 infection may play a role in the development and treatment of type 2 DM. Finally, we will examine the specific recommendations for neuropsychiatric treatment in the setting of HIV-1 infection complicated by type 2 DM.