Three Probable Cases of Immune Reconstitution Inflammatory Syndrome Manifesting as Type 1 Diabetes Mellitus during Treatment of HIV Infection

Abstract

A 38-year-old man had been diagnosed with human immunodeficiency virus (HIV) infection at 31 years old and started on antiretroviral therapy (ART). After 29 months, he became positive for GAD antibody (7.2 U/mL: RIA). After 78 months, he was diagnosed with type 1 diabetes. A 64-year-old man had been diagnosed with HIV infection at 63 years old and started on ART. Fifteen months later, he became positive for GAD antibody (12.5 U/mL; enzyme-linked immunosorbent assay [ELISA]) and was diagnosed with type 1 diabetes. A 53-year-old man had been diagnosed with HIV infection at 40 years old and started on ART. Thirteen years later, he became positive for GAD antibody (18 U/mL; ELISA) and was diagnosed with type 1 diabetes. These cases show that preceding viral infection and environmental factors leading to endoplasmic reticulum stress of pancreatic β cells are associated with the onset of type 1 diabetes after ART. Furthermore. previously reported cases also suggested that the use of anti-HIV drugs associated with the development of type 2 diabetes and the possession of general disease susceptibility haplotypes of type 1 diabetes are related to the development of type 1 diabetes after ART.