From New York, New York, USA:
A close friend of mine [age 32] who has had juvenile diabetes for the last 22 years was recently diagnosed with the HIV infection. What resources are out there for him that discuss managing HIV infection and diabetes?
To begin with I am supposing that your friend is HIV positive; but still in reasonable health apart from his diabetes and still employed. At this stage the first task is to establish a link with the nearest specialty AIDS clinic. Nowadays this has to a team that can deal not only with the clinical aspects of the diagnosis; but with the psychosocial issues. He will need to discuss with his doctor what drug therapy if any he is going to need at this stage and he should at least get acquainted with all the agencies that exist to help at a later stage if nee be with matters like housing food banks etc. Medicaid and insurance implications need to be discussed too. The team needs to be experienced and specialized because of the complexity of therapy. There are now eight approved drugs and more on the way and particular combinations need to be individually selected. If his CD4 cell count is above 500/ul and viral copies in the blood less than 5000/ml drug treatment may be deferred as long as the levels stay steady when tested at 3 month intervals. He may indeed be one of the lucky few in whom the disease takes many years to develop into AIDS or does not do so at all. Because the long term aims of an AIDS clinic and a Diabetes resource are different as are the expertise required I do not think that you will find a unit specially for the combination. You may consider doing volunteer work in one of the AIDS support organizations in your area and in this way or perhaps through the social worker you might get to hear of other diabetics with the same diagnosis and in this way you could start your own support group.
The HIV virus itself has no impact on the already destroyed beta cells after 22 years of Type 1 Diabetes, nor does it have any direct effect on glucose metabolism. A drug called Pentamidine that is used in certain infections may cause Diabetes or cause insulin dependence in Type 2 Diabetes. Once the implications of the positive HIV test have been coped with it would be important to fine tune his diabetes control so that he will be prepared to deal with intercurrent infections and nutritional issues if they arise later. You should make sure that both the Diabetes team and the AIDS team are aware of both diagnoses. If your friend has access to the Internet he may find help at www.helix.com
Original posting 20 Mar 97
Last Updated: Tuesday April 06, 2010 15:08:54
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