Impact of an Early Body Mass Index Maintenance Intervention at ART initiation on Diabetes Risk: Insights from a Simulation Study

BackgroundWeight gain after antiretroviral therapy (ART) initiation is linked to increased risk of developing type 2 diabetes mellitus among people with HIV (PWH). This study examines the potential impact of a hypothetical body mass index (BMI) maintenance intervention after ART initiation on reducing diabetes risk among PWH in the United States (US). MethodsUsing an agent-based simulation of comorbidities in PWH initiating ART in the US, we simulated a hypothetical two-year intervention, where BMI remained stable for individuals who would otherwise gain BMI. Individuals starting ART between 2013-2017 with a normal or overweight BMI and no prior diabetes diagnosis were eligible to participate. Participants were followed under an intervention scenario and a control scenario with no intervention. Diabetes risk was calculated as new diagnoses per 1,000 person-years over seven years after ART initiation. ResultsThe model forecasted that 171,000 PWH would initiate ART between 2013-2017, with 73% meeting eligibility criteria. Without intervention, 66% were expected to gain BMI, and 12% would become obese. The forecasted diabetes risk was 10.7 per 1,000 person-years, with approximately 9,500 new diagnoses over seven years after ART initiation. Under the hypothetical intervention, diabetes risk was reduced by 19% and a median of 1,800 diagnoses were averted. Subgroup analyses showed the largest risk reductions among women who inject drugs and Hispanic heterosexual men. ConclusionPreventing BMI increases in ART initiators could significantly reduce diabetes risk and improve health outcomes among PWH. Tailored weight maintenance strategies are needed to address diverse subgroup needs.