HIV and diabetes risk: fat scarring may explain why

What happened in this HIV and diabetes risk study

A UC San Francisco research team reported a possible biological link that may help explain HIV and diabetes risk even when HIV is well controlled on modern medications.

In blood samples and fat biopsies, the team found more fat-tissue fibrosis (scarring) in people living with HIV, and that scarring was associated with insulin resistance, a key predictor of type 2 diabetes.

The paper was published in JCI Insight as “A distinct form of fat fibrosis is linked to insulin resistance in people with HIV” (2026; DOI: 10.1172/jci.insight.195922).

What the evidence shows about HIV and diabetes risk (and who it applies to)

This was a cross-sectional comparison that measured people once, comparing 46 participants with well-controlled HIV to 74 participants without HIV.

None of the participants were obese or had diabetes, which means the findings speak to early metabolic changes that can appear before a diabetes diagnosis.

The researchers reported that fat fibrosis in people with HIV was evident regardless of body weight or the specific types of HIV medications participants were taking.

• Study design: one-time measurements of blood and fat biopsies (cross-sectional)
• Participants: 46 with well-controlled HIV vs 74 without HIV
• Exclusions: no obesity and no diabetes in either group
• Main association: more fat fibrosis in HIV group, linked with insulin resistance

Mechanism clues: fibrosis, gene activity, and endotrophin

The study suggests a pathway for HIV and diabetes risk that centers on a distinct pattern of fat-tissue remodeling rather than obesity alone.

In fat biopsies, genes involved in remodeling the extracellular matrix (supportive material around fat cells) and immune response were more active, while pathways controlling insulin signaling and lipid metabolism were less active.

The researchers also found higher blood levels of endotrophin in people with HIV, and reported that endotrophin reflected both fat fibrosis and insulin resistance, raising the possibility of a future blood marker for scarred fat.

• Fat fibrosis was linked to insulin resistance in participants with HIV
• Gene expression shifts included: higher extracellular matrix remodeling and immune response activity
• Lower activity was seen in: insulin signaling and lipid metabolism pathways
• Endotrophin was higher in blood and tracked with fibrosis and insulin resistance

Practical context for managing metabolic health with HIV and diabetes risk

For metabolic health monitoring, the study highlights that HIV and diabetes risk may not always be obvious from body weight alone.

The authors suggest that a blood marker of scarred fat could eventually help identify which patients are at highest risk, although this is not presented as a ready-to-use clinical test in the report.

If confirmed in future work, the findings could shift attention toward earlier detection of insulin resistance and fat-tissue changes in people living with well-controlled HIV, even when standard risk cues like obesity are absent.

Limitations and what the study cannot prove yet

This study cannot show that fat scarring causes insulin resistance or diabetes because the researchers measured participants only once.

The authors note they could not determine whether fat scarring directly leads to insulin resistance or diabetes, so the results should be read as an association and a first step toward understanding diabetes in the context of HIV.

The report frames endotrophin as a potential marker that might someday help predict metabolic risk, but it does not establish how it would be used in routine care or what thresholds would matter.