{"doi":"10.1101/2025.11.05.25339607","title":"Impact of an Early Body Mass Index Maintenance Intervention at ART initiation on Diabetes Risk: Insights from a Simulation Study","abstract":"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.","journal":"medRxiv","year":2025,"id":580309,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9517,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1491128,"name":"Yao Zhao","orcid":"0000-0001-9845-8770","position":1,"is_corresponding":false},{"id":449207,"name":"Elizabeth Humes","orcid":"0000-0003-3432-7688","position":2,"is_corresponding":false},{"id":450227,"name":"Lucas Gerace","orcid":null,"position":3,"is_corresponding":false},{"id":1491129,"name":"Kendall Reid","orcid":"0000-0002-2105-6471","position":4,"is_corresponding":false},{"id":272406,"name":"Catherine R. Lesko","orcid":"0000-0002-1717-2592","position":5,"is_corresponding":false},{"id":620453,"name":"Katherine E. Kurgansky","orcid":"0000-0001-9357-0034","position":6,"is_corresponding":false},{"id":240259,"name":"John R. Koethe","orcid":"0000-0001-6490-6942","position":7,"is_corresponding":false},{"id":240239,"name":"Peter F. Rebeiro","orcid":"0000-0003-1951-9104","position":8,"is_corresponding":false},{"id":240237,"name":"Kassem Bourgi","orcid":"0000-0001-9734-7489","position":9,"is_corresponding":false},{"id":242505,"name":"Kristine M. Erlandson","orcid":"0000-0003-0808-6729","position":10,"is_corresponding":false},{"id":311291,"name":"Kelly A. Gebo","orcid":"0000-0003-4010-398X","position":11,"is_corresponding":false},{"id":240243,"name":"Keri N. Althoff","orcid":"0000-0002-5068-6595","position":12,"is_corresponding":false},{"id":413290,"name":"Parastu Kasaie","orcid":"0000-0002-3744-9501","position":0,"is_corresponding":true}],"reference_count":52,"raw_metadata":null,"created_at":"2026-07-19T02:58:38.868285Z","pmid":"41282892","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}