Annals of epidemiology · 2026
Impact of an Early Body Mass Index Maintenance Intervention at ART initiation on Diabetes Risk: Insights from a Computer Simulation Study.
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Kasaie Parastu, Zhao Yao, Humes Elizabeth, Gerace Lucas, Reid Kendall, Lesko Catherine R, Kurgansky Katherine E, Koethe John R, Rebeiro Peter F, Bourgi Kassem, Erlandson Kristine M, Gebo Kelly, Althoff Keri N
Аннотация
BACKGROUND: Weight gain after antiretroviral therapy (ART) initiation increases type 2 diabetes risk among people with HIV (PWH). We assessed whether a hypothetical body mass index (BMI) maintenance intervention post-ART initiation could reduce diabetes risk among PWH in the United States.
METHODS: We used an agent-based simulation of PWH to simulate a two-year intervention to prevent BMI gain after ART initiation. Eligible participants were ART initiators (2013-2017) with a normal or overweight BMI (18.5-30 kg/m2) and no prior diabetes diagnosis. Participants were followed under intervention and control (no intervention) scenarios. Diabetes risk was calculated as new diagnoses per 1,000 person-years over seven years after ART initiation.
RESULTS: The model forecasted a median of 171,000 ART initiations between 2013-2017, with 73% eligible for this intervention. Without intervention, 66% would gain BMI, and 12% would become obese in the first two years post-ART initiation. The forecasted diabetes risk was 10.7 per 1,000 person-years (9,500 new diagnoses over seven years). The intervention reduced diabetes risk (relative risk=0.86; 0.82-0.89), averting a median of 1,300 cases, with the largest reductions among women who inject drugs and Hispanic heterosexual men.
CONCLUSION: Preventing BMI increases post-ART initiation could significantly reduce diabetes risk and improve health outcomes among PWH. Tailored weight maintenance strategies are needed to address diverse subgroup needs.
METHODS: We used an agent-based simulation of PWH to simulate a two-year intervention to prevent BMI gain after ART initiation. Eligible participants were ART initiators (2013-2017) with a normal or overweight BMI (18.5-30 kg/m2) and no prior diabetes diagnosis. Participants were followed under intervention and control (no intervention) scenarios. Diabetes risk was calculated as new diagnoses per 1,000 person-years over seven years after ART initiation.
RESULTS: The model forecasted a median of 171,000 ART initiations between 2013-2017, with 73% eligible for this intervention. Without intervention, 66% would gain BMI, and 12% would become obese in the first two years post-ART initiation. The forecasted diabetes risk was 10.7 per 1,000 person-years (9,500 new diagnoses over seven years). The intervention reduced diabetes risk (relative risk=0.86; 0.82-0.89), averting a median of 1,300 cases, with the largest reductions among women who inject drugs and Hispanic heterosexual men.
CONCLUSION: Preventing BMI increases post-ART initiation could significantly reduce diabetes risk and improve health outcomes among PWH. Tailored weight maintenance strategies are needed to address diverse subgroup needs.