Does switching to integrase inhibitors increase the risk of developing diabetes in HIV patients?
Integrase strand transfer inhibitors (INSTIs) are a common class of antiretroviral drugs used to treat HIV. Some studies have found that switching to an INSTI may raise the risk of metabolic problems, including diabetes. This answer reviews the evidence from recent research on whether switching to an INSTI increases diabetes risk.
What the research says
A large study using data from the REPRIEVE trial looked at people with HIV who switched to an INSTI compared to those who stayed on a non-INSTI regimen. The study found that switching to an INSTI was linked to a higher risk of developing diabetes 49. The study included over 5,000 participants from 12 countries and followed them for up to 5 years 9. Another study from South Africa found that patients switching from efavirenz to dolutegravir (an INSTI) gained more weight and had a higher risk of hypertension, which are both risk factors for diabetes 10. Weight gain is a known side effect of INSTIs, and excess weight can lead to insulin resistance and diabetes 4910. While these studies show an association, they do not prove that INSTIs directly cause diabetes. Other factors like age, weight, and overall health also play a role.
What to ask your doctor
- What is my personal risk of developing diabetes if I switch to an INSTI?
- How often should I have my blood sugar checked after switching to a new HIV medication?
- Are there ways to reduce weight gain or metabolic side effects while on an INSTI?
- Would a different class of HIV drugs be a safer option for me given my health history?
- What lifestyle changes can help lower my diabetes risk while on HIV treatment?
This question is drawn from common patient questions about Diabetes & Endocrinology and answered using cited medical research. We do not provide individualized advice.