Autoimmune Diabetes In A Patient With Human Immunodeficiency Virus on Anti-Retroviral Therapy With Literature Review

Abstract

ABSTRACT: Objective: Diabetes that develops in human immunodeficiency virus-infected individuals is typically classified as type 2 diabetes mellitus. Although less commonly reported, it has been shown that autoimmune diabetes can also develop in this population. Methods: We present a case of a patient found to have autoimmune diabetes following initiation of anti-retroviral therapy. Results: A 68-year-old, African American man with human immunodeficiency virus had a nadir CD4 count of 2 cells/μL, which improved with anti-retroviral therapy. He was subsequently diagnosed with type 2 diabetes mellitus but developed worsening glycemic control. Further investigation demonstrated an elevated glutamic acid decarboxylase antibody level >250 IU/mL and a declining C peptide level from 1.82 ng/mL to 0.56 ng/mL. He was ultimately diagnosed with autoimmune diabetes that was treated with insulin glargine and insulin aspart with improvement in his glycemic control. Conclusion: Autoimmune diabetes in this case was attributed to immune reconstitution after anti-retroviral therapy led to recovery from a significantly low CD4 count. While this phenomenon has been described in previous case reports, our case was unique in that autoimmune diabetes affected an older African American man, a different demographic than previously reported. Although the true mechanism of this association remains unknown, the recognition of autoimmune diabetes is crucial as it greatly impacts diabetes management. Abbreviations: AIDS acquired immunodeficiency syndrome ART anti-retroviral therapy BMI body mass index DKA diabetic ketoacidosis GAD glutamic acid decarboxylase HIV human immunodeficiency virus IDDM insulin-dependent diabetes mellitus IRIS immune reconstitution inflammatory syndrome LADA latent autoimmune diabetes in the adult T1DM type 1 diabetes mellitus T2DM type 2 diabetes mellitus