Alcohol use disorders (AUDs) frequently exist among persons living with HIV/AIDS (PLWHA). Chronic alcohol consumption, HIV infection, and anti-retroviral therapy (ART) are independently associated with impairments in glucose-insulin dynamics. Previous studies from our laboratory have shown that chronic binge alcohol (CBA) administration decreases body mass index, attenuates weight gain, and accentuates skeletal muscle wasting at end-stage disease in non-ART treated simian immunodeficiency virus (SIV)-infected male rhesus macaques. The aim of this study was to investigate whether CBA and ART alone or in combination alter body composition or glucose-insulin dynamics in SIV-infected male rhesus macaques during the asymptomatic phase of SIV infection. Daily CBA or sucrose (SUC) administration was initiated 3 mos. prior to intrarectal SIVmac251 inoculation and continued until the study end point at 11 mos. post-SIV infection. ART or placebo was initiated 2.5 months after SIV infection and continued until study end point. Four treatment groups (SUC/SIV±ART and CBA/SIV±ART) were studied. CBA/SIV macaques had a significantly decreased circulating adiponectin and resistin levels relative to SUC/SIV macaques and reduced disposition index (DI), acute insulin response to glucose (AIRg), insulin and C-peptide release during frequently sampled intravenous glucose tolerance test, irrespective of ART status. No statistically significant differences were observed in HOMA-insulin resistance (IR) values, body weight, total body fat, abdominal fat, or total lean mass or bone health among the four groups. These findings demonstrate CBA-mediated impairments in glucose-insulin dynamics and adipokine profile in asymptomatic SIV-infected macaques, irrespective of ART.