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

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