by Michel Morris,Johns Hopkins University

Diabetes mellitus affects more than 10% of people with HIV, and its incidence is rising as the population ages, according to the National Institutes of Health. Antiretroviral therapies that treat HIV by blocking specific enzymes the virus uses to multiply can cause metabolic complications, including weight gain and insulin resistance. Since 2015, integrase strand transfer inhibitor-based regimens have been recommended as first-line treatment. In a new Johns Hopkins Medicine study, researchers found adults with HIV who switched from protease inhibitors to integrase inhibitors were at increased risk of diabetes.

The studywas published inThe Lancet HIV.

"These findings help people with HIV make informed decisions when switching medications," says lead study author Yoseob Joseph Hwang, M.D., M.Sc. "Our analysis is not intended to discourage switching medications, but rather to inform patients and their treating clinicians of the potential metabolic risks that should be weighed in making individualized treatment decisions in such common clinical scenarios."

Hwang says the researchers emulated a target trial of 13,071 adults with HIV in the U.S. and Canada between 2016 and 2022. Participants without diabetes who had used non-nucleoside reverse transcriptase inhibitors or protease inhibitors for more than 180 days were followed from encounters in which they continued those medications or switched to an integrase strand transfer inhibitor for up to five years.

Researchers found a 38% higher risk of diabetes in people with HIV after switching from protease inhibitors to integrase strand transfer inhibitors. Hwang says this observation indicates that the medication change may have anadverse metabolic impact, which may warrant close monitoring early after a switch, regardless of weight gain.

"Prior studies have looked at diabetes risk in new users of integrase strand transfer inhibitors," Hwang explained. "Our study specifically looked at people with HIV who switched to integrase strand transfer inhibitors, contributing to the growing body of evidence that implicates the medication with diabetes risk."

Hwang says the next steps in this research are to determine how integrase inhibitors affect people with preexisting diabetes.

Publication details Y Joseph Hwang et al, Incident diabetes after switching to integrase strand transfer inhibitors in people with HIV in the USA and Canada: a cohort study, The Lancet HIV (2026). DOI: 10.1016/s2352-3018(25)00335-2 Journal information: The Lancet HIV