A 39-year-old man comes to the physician because of a 3-month history of fatigue. During this period, he has also had a 7.7-kg (17-lb) weight loss, despite having a normal appetite. He is sexually active with 3 female partners and uses condoms inconsistently. He is found to be HIV-positive and his CD4 count is 45/mm³. The patient's condition improves on a newly instituted treatment, but 4 weeks later at outpatient follow-up he is found to have significantly elevated fasting blood glucose. Which of the following medications is most likely responsible for his hyperglycemia?

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Eductional Objective: Protease inhibitors are HIV antiretroviral medications that inhibit cleavage of the polypeptide precursor into mature viral proteins.  Their side effects as a class include hyperglycemia, lipodystrophy, and drug-drug interactions due to inhibition of cytochrome P450.

A 39-Year-Old Man Comes to the Physician Because of a 3-Month