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

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.