Yusuf Afacan, MD
Medical Director, AIDS Center Program
Woodhull Medical Center

Q. Is it common to have both diabetes and HIV?

A. At Woodhull, I care for about 1,000 HIV positive patients and approximately 10 percent have diabetes. That’s because our patients as a group are more likely to be diabetic, not because their HIV status in itself causes diabetes. People living with HIV who take antiretroviral medications, also known as protease inhibitors (PIs), may face a higher risk for type 2 diabetes. Some PIs have been found to cause insulin resistance and can therefore trigger diabetes -- particularly among patients who are already at high risk due to their family history or other lifestyle choices.

Q. What are some unique challenges of having both conditions?

A. Many patients with diabetes are overweight and need to bring their weight under control to help balance their blood sugar levels. However, if someone is HIV positive, any weight loss may be seen as a complication of HIV. Some of my patients worry that weight loss is a visible sign that generates public speculation about their HIV/AIDS status. I recognize it is difficult to manage the medical, psychological, and social pressures one may face with both conditions. That’s why it is important to have a comprehensive care team - a primary care doctor, specialists, social workers, and psychologists - working together to help the patient. That’s how we do it at HHC.

Q. What are common conditions to watch out for if I have both?

A. HIV can affect kidney function, and diabetes also affects the kidneys. Therefore, the risk of kidney disease is greater. You should see a doctor regularly who can help you create a lifestyle and medication plan to properly care for both conditions. Also, both HIV and diabetes tend to exacerbate the risk of developing depression. HIV affects one’s social life and sex life. Diabetes affects eating and lifestyle. It’s a lot to manage. So, be sure to also take good care of your mental health and don’t hesitate to seek help if you need it.

Q. What should I do to better manage my diabetes and HIV?

A. You should maintain an optimal weight through regular exercise and a healthy diet to best manage both conditions. You need a protein rich diet to help your immune system, and you also need a low carbohydrate diet to manage your sugar and your weight. An overall balanced diet is best. You probably take many medications with food, so it is increasingly important that you know which foods are best for you. Additionally, some of the HIV medications can also increase appetite and may make it more difficult to maintain a healthy body weight. Like all diabetics, you should regularly monitor glucose levels, get annual foot and eye exams, control your cholesterol and blood pressure, and see your care team often.

Q. How does exercise help?

A. In the past, patients with HIV were significantly weakened by their condition, which would not only mask their diabetes but also limit their ability to exercise. With the introduction of rapid HIV tests that show results in 20 minutes, we are now able to catch folks at an early stage of their disease. With the advancement of HIV medications, patients are able to live healthy lives. If you have both HIV and diabetes, exercise is key to managing your weight, blood sugar, and blood pressure, and is a vital part of the healthy lifestyle that can help you successfully manage both conditions.

Q. What do I need to know about my medication regimen if I have both conditions?

A. HIV medicines have been simplified in the last five years – many patients are able to control HIV with one to three pills a day. As I mentioned, some of these drugs may lead to weight gain, so it is important to have a tightly controlled diet. If you have type 2 diabetes, you may also need an oral anti-diabetes medication once or twice a day. Though there are no common conflicts between insulin or oral anti-diabetic drugs and HIV medications, some PIs tend to increase sulfonylurea levels and cause blood sugar levels to drop. It is important to understand all your medications, regularly discuss your regimen with your care team, and monitor your conditions much more closely to reach a balanced level of both medications.

Q. What is tougher to fight, HIV or Diabetes?

A. I believe that, in the long term, diabetes can cause more damage than having HIV. HIV can be properly managed with medication. To fight diabetes, one must make a significant lifestyle change. Too many patients are more committed to sticking to their HIV medicine than sticking to their diabetes fighting regimen. I believe lack of awareness about the dangers of diabetes is part of the problem. When folks die of diabetes, it is never said diabetes was the cause. They say it’s a heart attack, stroke, or kidney damage. So, folks don’t make a connection between their death and their diabetes condition. When someone dies of HIV, everyone knows it was HIV.