The effect of hypothetical interventions to limit weight gain on incident type 2 diabetes mellitus among people with HIV initiating antiretroviral therapy in the United States, 2012-2021

Among people with HIV (PWH), initiating antiretroviral therapy (ART) is associated with weight gain that might increase the risk of cardiometabolic outcomes. We estimated the effect of hypothetical interventions to restrict increases in body mass index (BMI) in the two years after ART initiation on the 7-year risk of incident type-2 diabetes mellitus (T2DM) among PWH in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) clinical cohorts using the parametric extended g-formula. Among 13,822 normal weight or overweight PWH (BMI ≥18.5 and ≤29.9 kg/m2) who initiated ART between 2012-2021, the 7-year risk of T2DM was 5.6% (95% confidence interval [CI]: 4.8%, 6.3%). Compared to no intervention on BMI, if BMI increase during the first 2 years was capped at 5% of baseline BMI, the risk ratio (RR) for T2DM risk was 0.94 (95% CI, 0.86, 1.03); if BMI was capped at 29.9 kg/m2, RR=0.88 (95% CI, 0.80, 0.97); and if PWH were prevented from gaining any weight over the first 2 years, RR=0.81 (95% CI, 0.72, 0.92). These results provide preliminary evidence to promote studies of real weight maintenance interventions among PWH initiating ART.