Newly diagnosed type 1 diabetes mellitus in a human immunodeficiency virus-infected patient with antiretroviral therapy-induced immune reconstitution inflammatory syndrome: a case report
Abstract Background Diabetes that develops in human immunodeficiency virus (HIV)-infected patients who receive antiretroviral therapy (ART) is usually type 2 diabetes mellitus (T2DM); however, autoimmune diabetes, such as type 1 diabetes mellitus (T1DM) can also develop in this population. After tre...
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-023-08605-1 |
| _version_ | 1797453735412105216 |
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| author | Min-ChunYeh Han-Chuan Chuang Shuen-Fu Weng Chung-Huei Hsu Chen-Ling Huang Yu-Pei Lin Yan-Yu Lin Yu-Shan Hsieh |
| author_facet | Min-ChunYeh Han-Chuan Chuang Shuen-Fu Weng Chung-Huei Hsu Chen-Ling Huang Yu-Pei Lin Yan-Yu Lin Yu-Shan Hsieh |
| author_sort | Min-ChunYeh |
| collection | DOAJ |
| description | Abstract Background Diabetes that develops in human immunodeficiency virus (HIV)-infected patients who receive antiretroviral therapy (ART) is usually type 2 diabetes mellitus (T2DM); however, autoimmune diabetes, such as type 1 diabetes mellitus (T1DM) can also develop in this population. After treatment with ART, patients might experience clinical deterioration following an increase in the CD4 cell count, which is termed immune reconstitution inflammatory syndrome (IRIS). Here, we describe an HIV-infected patient on ART who developed T1DMat due to IRIS, highlighting the clinical complexity in diagnosis and treatment. Case presentation A 36-year-old man infected with HIV had a nadir CD4 cell count of 15.53/μL before medication, which increased to 429.09/μL after 9 months of regular ART. The fasting serum glucose at 9 months was between 96 mg/dL and 117 mg/dL. After 11 months of ART, the patient was admitted to hospital for diabetic ketoacidosis (DKA) and Graves’ disease (GD). Noninsulin antidiabetics (NIADs) were prescribed following the resolution of DKA. However, poor glycemic control was noted despite well-titrated NIADs. Further investigation demonstrated poor pancreatic beta cell function and elevated anti-glutamic acid decarboxylase (anti-GAD) and anti-tyrosine phosphatase-like insulinoma antigen 2 (anti-IA2) titers. According to the results, he was diagnosed with T1DM and received multiple daily injections(MDI) of insulin. The regimen of MDI was insulin degludec as basal insulin and insulin aspart as prandial insulin. After MDI therapy, his glycemic control was improved. Conclusion In this case, T1DM was ascribed to IRIS. Although this phenomenon has been demonstrated in previous case reports, further study is necessary to realize the mechanism of this association. Therefore, we emphasize that when HIV-infected patients on ART experience an unstable blood glucose level and abnormal thyroid function, physicians should consider T1DM and GD associated with ART-induced IRIS to reduce the subsequent complications and more serious endocrine dysfunction. |
| first_indexed | 2024-03-09T15:27:08Z |
| format | Article |
| id | doaj.art-4e632bc0faca4c41b9697c3e04af5e68 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-03-09T15:27:08Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-4e632bc0faca4c41b9697c3e04af5e682023-11-26T12:28:15ZengBMCBMC Infectious Diseases1471-23342023-09-012311610.1186/s12879-023-08605-1Newly diagnosed type 1 diabetes mellitus in a human immunodeficiency virus-infected patient with antiretroviral therapy-induced immune reconstitution inflammatory syndrome: a case reportMin-ChunYeh0Han-Chuan Chuang1Shuen-Fu Weng2Chung-Huei Hsu3Chen-Ling Huang4Yu-Pei Lin5Yan-Yu Lin6Yu-Shan Hsieh7Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University HospitalDivision of Infection Diseases, Department of Internal Medicine, Taipei Medical University HospitalDivision of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University HospitalDivision of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University HospitalDivision of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University HospitalDivision of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University HospitalDivision of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University HospitalSchool of Nursing, National Taipei University of Nursing and Health SciencesAbstract Background Diabetes that develops in human immunodeficiency virus (HIV)-infected patients who receive antiretroviral therapy (ART) is usually type 2 diabetes mellitus (T2DM); however, autoimmune diabetes, such as type 1 diabetes mellitus (T1DM) can also develop in this population. After treatment with ART, patients might experience clinical deterioration following an increase in the CD4 cell count, which is termed immune reconstitution inflammatory syndrome (IRIS). Here, we describe an HIV-infected patient on ART who developed T1DMat due to IRIS, highlighting the clinical complexity in diagnosis and treatment. Case presentation A 36-year-old man infected with HIV had a nadir CD4 cell count of 15.53/μL before medication, which increased to 429.09/μL after 9 months of regular ART. The fasting serum glucose at 9 months was between 96 mg/dL and 117 mg/dL. After 11 months of ART, the patient was admitted to hospital for diabetic ketoacidosis (DKA) and Graves’ disease (GD). Noninsulin antidiabetics (NIADs) were prescribed following the resolution of DKA. However, poor glycemic control was noted despite well-titrated NIADs. Further investigation demonstrated poor pancreatic beta cell function and elevated anti-glutamic acid decarboxylase (anti-GAD) and anti-tyrosine phosphatase-like insulinoma antigen 2 (anti-IA2) titers. According to the results, he was diagnosed with T1DM and received multiple daily injections(MDI) of insulin. The regimen of MDI was insulin degludec as basal insulin and insulin aspart as prandial insulin. After MDI therapy, his glycemic control was improved. Conclusion In this case, T1DM was ascribed to IRIS. Although this phenomenon has been demonstrated in previous case reports, further study is necessary to realize the mechanism of this association. Therefore, we emphasize that when HIV-infected patients on ART experience an unstable blood glucose level and abnormal thyroid function, physicians should consider T1DM and GD associated with ART-induced IRIS to reduce the subsequent complications and more serious endocrine dysfunction.https://doi.org/10.1186/s12879-023-08605-1Type 1 diabetes mellitusGraves’ diseaseImmune reconstitution inflammatory syndromeHuman immunodeficiency virusAntiretroviral therapy |
| spellingShingle | Min-ChunYeh Han-Chuan Chuang Shuen-Fu Weng Chung-Huei Hsu Chen-Ling Huang Yu-Pei Lin Yan-Yu Lin Yu-Shan Hsieh Newly diagnosed type 1 diabetes mellitus in a human immunodeficiency virus-infected patient with antiretroviral therapy-induced immune reconstitution inflammatory syndrome: a case report BMC Infectious Diseases Type 1 diabetes mellitus Graves’ disease Immune reconstitution inflammatory syndrome Human immunodeficiency virus Antiretroviral therapy |
| title | Newly diagnosed type 1 diabetes mellitus in a human immunodeficiency virus-infected patient with antiretroviral therapy-induced immune reconstitution inflammatory syndrome: a case report |
| title_full | Newly diagnosed type 1 diabetes mellitus in a human immunodeficiency virus-infected patient with antiretroviral therapy-induced immune reconstitution inflammatory syndrome: a case report |
| title_fullStr | Newly diagnosed type 1 diabetes mellitus in a human immunodeficiency virus-infected patient with antiretroviral therapy-induced immune reconstitution inflammatory syndrome: a case report |
| title_full_unstemmed | Newly diagnosed type 1 diabetes mellitus in a human immunodeficiency virus-infected patient with antiretroviral therapy-induced immune reconstitution inflammatory syndrome: a case report |
| title_short | Newly diagnosed type 1 diabetes mellitus in a human immunodeficiency virus-infected patient with antiretroviral therapy-induced immune reconstitution inflammatory syndrome: a case report |
| title_sort | newly diagnosed type 1 diabetes mellitus in a human immunodeficiency virus infected patient with antiretroviral therapy induced immune reconstitution inflammatory syndrome a case report |
| topic | Type 1 diabetes mellitus Graves’ disease Immune reconstitution inflammatory syndrome Human immunodeficiency virus Antiretroviral therapy |
| url | https://doi.org/10.1186/s12879-023-08605-1 |
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