HIV med choices/side effects

[tallslenderguy]

i started on Biktarvy about 11 months ago. i'm a nurse, so pretty experienced in assessing. i smelled sugar in my pee, so bought a glucometer on Amazon, and my fasting blood glucose was in the 120's-130's.  i had upcoming labs for my routine HIV status screening and so asked my ID to add on an A1c (test for diabetes). It was 7.2 which officially makes me type 2 diabetic (DM2). i'm a tall guy and my BMI has never been over normal, though it has crept up to the top in of normal range. i did some searching and turns out Biktarvy does have some association with DM2. It's hard to know if it is causative, but looking suspicious and it does have a history. 

Anyone else run into this? i have an appointment with my ID this Thursday and anticipate a med change, i also tested in the detectable range as well, so i am questioning the Biktarvy. In my searches i have also found HIV meds with lamivudine (e.g. "Dovata") have some possible effect at reversing DM2, some have suggested it as a off label treatment for DM2. i have read mixed reviews on Dovata, but that's true about all meds. Plus, there are other meds with lamivudine.

Interested in anyone else's experience with the HIV meds and new onset of DM2, if you made the connection and discontinued the med and reversed the DM2?  Or any other info you care to share.

Thanks guys.

[Guest]

I was on Atripla for many years before switching to Biktarvy about 18 months ago, mainly due to the fact that Biktarvy is gentler on the kidneys. I haven’t seen any issue with sugar. The only thing I’ve noticed is weight gain, even though I’ve been watching food intake and trying to walk at least 12,000 steps a day. 

[BootmanLA]

I already had minor issues with A1C before switching to Biktarvy, which my HIVdoctor did due to elevated creatinine levels. On my nephrologist's recommendation my HIV specialist switched my diabetes treatment to Glymiperide, which, like Biktarvy, is also kidney friendly. Even after dropping to every other day dosing for the Glymiperide, my A1C has been below 5.5 since. So while the Biktarvy may be slightly boosting your blood sugar level, it may also be easy to bring under control.

[tallslenderguy]

Thanks for the responses guys. i'm working on reversing the blood glucose with diet. There is some info that associates Biktarvy with diabetes 2 (DM2), and weight gain, what i haven't found is info stating which comes first. DM2 is caused by excess intracellular fat so wondering if the Biktarvy association is related to the increased weight/fat gain vs a direct correlation between DM2 and Biktarvy.

my BMI has never been above normal, but when i am at the bottom end of normal, i loose trunk fat which is a marker for insulin resistance, so i'm in the process of losing that and working toward a lower BMI, especially reducing my fat ratio. my suspicion is that Biktarvy is not necessarily causative, but is a factor. Going to talk with my ID doc on Thursday and consider continuing and see if i can affect this through diet. my metabolic panel blood work is perfect, but i'm now detectable (85 copies on the HIV RNA Ultra test),  and have not been for a long time, so that all by itself may necessitate a med change.

[tallslenderguy]

Hey Guys, just an update to anyone following this. The diabetes thing got my attention. i've always been pretty good with diet never been beyond a 

'normal' BMI in my life. i got really strict with my diet after getting an A1c of 7.2 , in February 2021, which is officially diabetic. i am specially educated in reversing certain diseases through diet, type 2 diabetes among them (DM2), so went total Whole Food Plant Based Diet with no added oil (WFPBDNO), with a few cheat meals. For the most part, no animal and kept my daily fat intake under 20grams (fat is what causes DM2).  i got another A1c two months later and had dropped it to 6.3, which is pre-diabetic. i stayed on the Biktarvy after talking with my ID doctor, and retested undetectable on all counts. Doesn't look like the BIktarvy was an issue for me, and i'm glad, it has a good record as a med and i have no issues with it from my labs. 

[BootmanLA]

3 hours ago, tallslenderguy said:

Hey Guys, just an update to anyone following this. The diabetes thing got my attention. i've always been pretty good with diet never been beyond a 

'normal' BMI in my life. i got really strict with my diet after getting an A1c of 7.2 , in February 2021, which is officially diabetic. i am specially educated in reversing certain diseases through diet, type 2 diabetes among them (DM2), so went total Whole Food Plant Based Diet with no added oil (WFPBDNO), with a few cheat meals. For the most part, no animal and kept my daily fat intake under 20grams (fat is what causes DM2).  i got another A1c two months later and had dropped it to 6.3, which is pre-diabetic. i stayed on the Biktarvy after talking with my ID doctor, and retested undetectable on all counts. Doesn't look like the BIktarvy was an issue for me, and i'm glad, it has a good record as a med and i have no issues with it from my labs. 

FWIW: My ID doctor switched me TO Biktarvy (from Genvoya) precisely because Genvoya was probably one of the things causing my A1C to rise; Biktarvy is supposed to be both kidney-safe and pancreas-safe.

Given the "lookback" period involved in an A1c level, you may find it continues to drop if you stay on the diet for the most part. 

[haireebear]

My doctor switched me to Biktarvy about....a year ago?    Other than horrible insomnia, which has lessened significantly, about 3 months into taking it, I had blood tests and I tested pre-diabetic for the first time in my life.   Now....I am 46 and obese, so to any normal person this would seem like a given, but my blood sugar has always been normal no matter what my weight.    So, this was totally surprising.   And of course my doctor blamed it on my weight, but now that I read this, I wonder if it has to do with the Biktarvy.   Thank you for posting this.   I'm seeing him for updated blood tests on Monday, so I will bring this up.