References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
Type 2 diabetes is more common in people living with HIV than in the general population. Contributing factors include chronic inflammation from HIV, some antiretroviral medications, weight gain on treatment, and the general ageing of the HIV population. Managing blood sugar well is important because diabetes adds to the cardiovascular risk that HIV already brings.
Here’s what to know about the link and how to reduce your risk.
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Why Diabetes Is More Common with HIV
- Chronic inflammation — HIV-related inflammation affects insulin sensitivity
- Some ART drugs — older protease inhibitors in particular can affect blood sugar
- Weight gain — common on modern integrase inhibitor-based regimens
- Lipodystrophy — body fat redistribution from older drugs affects metabolism
- Ageing — the HIV population is getting older, and diabetes risk rises with age
- Family history and ethnicity — the same risk factors as the general population
Screening
Your HIV clinic checks blood glucose or HbA1c regularly as part of routine monitoring. This picks up pre-diabetes and diabetes early.
| Result | What It Means |
|---|---|
| HbA1c below 42 mmol/mol | Normal |
| HbA1c 42-47 mmol/mol | Pre-diabetes — increased risk |
| HbA1c 48 mmol/mol or above | Diabetes |
Managing Diabetes with HIV
Lifestyle
- Balanced diet with reduced refined sugar and processed carbohydrates
- Regular exercise — 150 minutes per week minimum
- Maintain a healthy weight
- Stop smoking
- Limit alcohol
Medication
Metformin is the usual first-line diabetes drug and is safe with most HIV medications. One interaction to note: dolutegravir raises metformin levels, so your dose may need adjusting. Your HIV team and GP should coordinate.
ART considerations
If your ART is contributing to insulin resistance or weight gain, your HIV team may consider switching to a different regimen. This should always be discussed rather than done on your own.
Cardiovascular Risk
Diabetes plus HIV significantly raises cardiovascular risk. This makes blood pressure control, cholesterol management and smoking cessation even more important. Your clinic will monitor all of these.
Read more: Blood pressure and HIV | Heart disease and HIV | Weight management
Frequently Asked Questions
Can HIV medication cause diabetes?
Some older HIV drugs can affect blood sugar. Modern regimens are less likely to cause diabetes directly, but weight gain on treatment can increase risk.
Is metformin safe with HIV medication?
Yes, with one caveat: dolutegravir increases metformin levels. Your doctor may adjust the metformin dose accordingly.
Should I see a separate diabetes specialist?
Your GP usually manages diabetes, but your HIV team should be involved to coordinate medication and monitoring. Some HIV clinics have integrated metabolic clinics.
Related reading
- A to Z of Sex: Sexual Health Terms Explained
- Alcohol and HIV: What You Need to Know
- Anxiety and HIV: Coping and Getting Support
- Are All STIs Curable?
- Blood Problems and HIV: Anaemia, Low Platelets and More
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
