PMID- 37730544 OWN - NLM STAT- MEDLINE DCOM- 20230922 LR - 20231122 IS - 1471-2334 (Electronic) IS - 1471-2334 (Linking) VI - 23 IP - 1 DP - 2023 Sep 20 TI - Newly diagnosed type 1 diabetes mellitus in a human immunodeficiency virus-infected patient with antiretroviral therapy-induced immune reconstitution inflammatory syndrome: a case report. PG - 619 LID - 10.1186/s12879-023-08605-1 [doi] LID - 619 AB - 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/muL before medication, which increased to 429.09/muL 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. CI - (c) 2023. BioMed Central Ltd., part of Springer Nature. FAU - Min-ChunYeh AU - Min-ChunYeh AD - Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan. FAU - Chuang, Han-Chuan AU - Chuang HC AD - Division of Infection Diseases, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan. FAU - Weng, Shuen-Fu AU - Weng SF AD - Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan. AD - Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan. FAU - Hsu, Chung-Huei AU - Hsu CH AD - Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan. FAU - Huang, Chen-Ling AU - Huang CL AD - Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan. FAU - Lin, Yu-Pei AU - Lin YP AD - Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan. FAU - Lin, Yan-Yu AU - Lin YY AD - Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan. FAU - Hsieh, Yu-Shan AU - Hsieh YS AD - School of Nursing, National Taipei University of Nursing and Health Sciences, No. 365, Mingde Rd., Beitou Dist, Taipei City, 112303, Taiwan. 228455300teresa@gmail.com. AD - Department of Research, Taipei Medical University Hospital, Taipei City, 11031, Taiwan. 228455300teresa@gmail.com. LA - eng PT - Case Reports PT - Journal Article DEP - 20230920 PL - England TA - BMC Infect Dis JT - BMC infectious diseases JID - 100968551 RN - 0 (Hypoglycemic Agents) SB - IM MH - Male MH - Humans MH - Adult MH - HIV MH - *Diabetes Mellitus, Type 1/complications/drug therapy MH - *Diabetes Mellitus, Type 2 MH - *Immune Reconstitution Inflammatory Syndrome/diagnosis/etiology MH - Hypoglycemic Agents MH - *HIV Infections/complications/drug therapy PMC - PMC10512543 OTO - NOTNLM OT - Antiretroviral therapy OT - Graves' disease OT - Human immunodeficiency virus OT - Immune reconstitution inflammatory syndrome OT - Type 1 diabetes mellitus COIS- The authors declare no competing interests. EDAT- 2023/09/21 00:42 MHDA- 2023/09/22 06:42 PMCR- 2023/09/20 CRDT- 2023/09/20 23:32 PHST- 2023/04/24 00:00 [received] PHST- 2023/09/12 00:00 [accepted] PHST- 2023/09/22 06:42 [medline] PHST- 2023/09/21 00:42 [pubmed] PHST- 2023/09/20 23:32 [entrez] PHST- 2023/09/20 00:00 [pmc-release] AID - 10.1186/s12879-023-08605-1 [pii] AID - 8605 [pii] AID - 10.1186/s12879-023-08605-1 [doi] PST - epublish SO - BMC Infect Dis. 2023 Sep 20;23(1):619. doi: 10.1186/s12879-023-08605-1.