We eavesdrop as one HIVer and his doc fit diabetes into the treatment plan.

Cast: Gregory Huang-Cruz, a 40-year-old skills counselor & Alexander McMeeking, MD, Cruz’s HIV doctor.
Scene: Doc’s office, New York City, late 2004.

Enter, Cruz: Diagnosed in 1999, he needs a strong first combo now that his CD4s have hit 226 and his viral load, 295,000. But powerhouse protease inhibitors (PIs) can raise insulin resistance. “We reviewed the pros and cons of each combo, including PIs,” McMeeking says. Fearing non-nuke side effects more than PIs’, Cruz picks Norvir-boosted Lexiva plus two-nuke Truvada.
Act Two: Three months later, Cruz’s virus is undetectable, but his blood sugar has spiked. His endocrinologist ups his insulin dose, a nutritionist trims his diet with lean meat and tofu and Cruz takes up sports. “We’re watching his blood sugar closely,” McMeeking says, but “we’re pleased he’s undetectable, and I’d like to sit tight with this combo.”

Curtain: If insulin, diet and exercise don’t deliver, McMeeking says he might swap a non-nuke for the PIs, but it’s Cruz’s call. Says Cruz, “I trust his judgment.” Applause.