title: Autoimmune diabetes in HIV-infected patients on highly active antiretroviral therapy.
abstract: BACKGROUND
  Various autoimmune diseases, especially autoimmune thyroid disease, are known to occur in HIV-infected patients on highly active antiretroviral therapy (HAART). However, no reports have described the development of autoimmune diabetes during HAART.
  
  
  OBJECTIVE
  Our objective was to investigate the clinical course of the development of autoantibodies and diabetes during HAART.
  
  
  METHODS
  Based on their high antiislet autoantibody titers and requirement for insulin therapy, we diagnosed three HIV-infected patients with autoimmune diabetes. To clarify the relationship between the development of an autoimmune reaction against pancreatic beta-cells and recovery of CD4+ T lymphocyte (CD4) counts, we retrospectively assayed stored samples of the patients' plasma for antiglutamic acid decarboxylase antibody (GAD-Ab).
  
  
  RESULTS
  No GAD-Ab was detected in the plasma samples of any of the three patients prior to HAART, and their CD4 counts were below 20 cells/microl at their nadir. The GAD-Ab tests became positive from 6 to 38 months after the start of HAART, and their conversion to positive followed a dramatic increase in the patients' CD4 count. Two patients developed diabetes after testing positive for GAD-Ab. Although one patient had mild diabetes prior to testing positive for GAD-Ab, the rapid worsening of glycemic control and introduction of insulin therapy almost coincided with the detection of GAD-Ab. The high magnitude of the CD4 increase during HAART and the timing of the detection of autoantibody were similar to the magnitude and timing reported in HAART-associated autoimmune thyroid disease.
  
  
  CONCLUSIONS
  Autoimmune diabetes develops in some HIV-infected patients after immune restoration during HAART.
authors.affiliation: Department of Diabetes and Metabolic Medicine, AIDS Clinical Center, National Center for Global Health and Medicine, Toyama 1-21-1, Shinjuku-ku, Tokyo 162-8655, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Takarabe
authors.forename: Yuka
authors.initials: Y
authors.lastname: Rokukawa
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Goto
authors.forename: Maki
authors.initials: M
authors.lastname: Takaichi
authors.forename: Masahide
authors.initials: M
authors.lastname: Okamoto
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Tsujimoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Noto
authors.forename: Miyako
authors.initials: M
authors.lastname: Kishimoto
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Kaburagi
authors.forename: Kazuki
authors.initials: K
authors.lastname: Yasuda
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Yamamoto-Honda
authors.forename: Kunihisa
authors.initials: K
authors.lastname: Tsukada
authors.forename: Miwako
authors.initials: M
authors.lastname: Honda
authors.forename: Katsuji
authors.initials: K
authors.lastname: Teruya
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kajio
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Kikuchi
authors.forename: Shinichi
authors.initials: S
authors.lastname: Oka
authors.forename: Mitsuhiko
authors.initials: M
authors.lastname: Noda
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001323:Autoantibodies / Q000276:immunology; D018791:CD4 Lymphocyte Count; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000276:immunology; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D008297:Male
chemical_list: D019380:Anti-HIV Agents; D001323:Autoantibodies