In this concluding episode of the series, Dr Tebelele and Dr Mashitisho discuss one of the most complex intersections in modern clinical medicine — the coexistence of HIV and diabetes. With South Africa bearing a high burden of both conditions, the discussion provides practical strategies for clinicians navigating overlapping management pathways, potential drug interactions, and the compounded effects of immunosuppression and metabolic dysfunction.

The speakers highlight how antiretroviral therapy (ART) and insulin or oral antidiabetic agents can influence one another, requiring careful dose titration, adherence monitoring, and side-effect management. The session reinforces a holistic, patient-centred approach that balances virological control with metabolic health, emphasising lifestyle intervention, continuity of care, and psychosocial support.

1. Describe the epidemiological overlap between HIV and diabetes in the South African context.
2. Recognise the metabolic effects of long-term antiretroviral therapy and how it may precipitate or worsen diabetes.
3. Identify drug–drug interactions between ART and common antidiabetic agents.
4. Develop integrated management plans for patients with dual HIV and diabetes diagnoses.
5. Apply patient-centred care strategies that address adherence, stigma, and long-term follow-up challenges.

• Manage HIV–diabetes comorbidity with a clear understanding of pharmacological interactions.
• Adjust antidiabetic and ART regimens to ensure optimal safety and efficacy.
• Implement multidisciplinary, patient-focused care models for dual management.
• Promote adherence through education, community support, and stigma reduction.
• Strengthening continuity of care and integrated chronic-disease management in resource-limited settings.

• Clinical overlap: HIV and diabetes often coexist due to ART-induced metabolic changes, ageing, and shared lifestyle risk factors.
• Antiretroviral impact: Protease inhibitors and certain nucleoside analogues can induce insulin resistance or dyslipidaemia.
• Medication management: Close monitoring of glucose levels is essential when adjusting ART or insulin therapy; Metformin remains a preferred first-line agent where tolerated.
• Adherence and stigma: Managing both conditions requires patient trust and ongoing education to combat treatment fatigue and social stigma.
• Holistic care: Integration of HIV and NCD management in primary care, ensuring alignment of treatment goals and reduced pill burden.
• Lifestyle and prevention: Emphasis on nutrition, exercise, smoking cessation, and mental health as pillars of long-term control.
• Systems perspective: Advocating for combined HIV–NCD clinics and community outreach models to improve outcomes.