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

Le résumé fourni par la source

Background: Weight 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). Methods: Using 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. Results: The 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. Conclusion: Preventing 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.

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