{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T13:32:35Z","timestamp":1768570355774,"version":"3.49.0"},"posted":{"date-parts":[[2025,11,6]]},"group-title":"HIV\/AIDS","reference-count":57,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,11,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>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).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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\u20132017 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.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The model forecasted that 171,000 PWH would initiate ART between 2013\u20132017, 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.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2025.11.05.25339607","type":"posted-content","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T22:40:15Z","timestamp":1762468815000},"source":"Crossref","is-referenced-by-count":0,"title":["Impact of an Early Body Mass Index Maintenance Intervention at ART initiation on Diabetes Risk: Insights from a Simulation Study"],"prefix":"10.64898","author":[{"given":"Parastu","family":"Kasaie","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yao","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Humes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucas","family":"Gerace","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2105-6471","authenticated-orcid":false,"given":"Kendall","family":"Reid","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine R.","family":"Lesko","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine E.","family":"Kurgansky","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John R.","family":"Koethe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter F.","family":"Rebeiro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kassem","family":"Bourgi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristine M.","family":"Erlandson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly","family":"Gebo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keri N","family":"Althoff","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"issue":"7","key":"2025110923500699000_2025.11.05.25339607v1.1","doi-asserted-by":"crossref","first-page":"e2334","DOI":"10.1093\/cid\/ciaa1904","article-title":"CD4 count at entry into care and at antiretroviral therapy prescription among adults with human immunodeficiency virus in the United States, 2005-2018","volume":"73","year":"2021","journal-title":"Clinical Infectious Diseases"},{"key":"2025110923500699000_2025.11.05.25339607v1.2","doi-asserted-by":"crossref","unstructured":"Bailin SS , Koethe JR . Weight Gain and Antiretroviral Therapy. Infectious Disease Clinics. 2024.","DOI":"10.1016\/j.idc.2024.04.005"},{"key":"2025110923500699000_2025.11.05.25339607v1.3","doi-asserted-by":"publisher","DOI":"10.1089\/aid.2015.0147"},{"key":"2025110923500699000_2025.11.05.25339607v1.4","doi-asserted-by":"crossref","unstructured":"Wu X , Zhang L , Lu Z , et al. Longitudinal trajectories of weight changes among people living with HIV on antiretroviral therapy: A group-based study. Iscience. 2023;26(11).","DOI":"10.1016\/j.isci.2023.108259"},{"key":"2025110923500699000_2025.11.05.25339607v1.5","doi-asserted-by":"crossref","unstructured":"Wohl DA , Koethe JR , Sax PE , et al. Antiretrovirals and Weight Change: Weighing the Evidence. Clinical Infectious Diseases. 2024:ciae191.","DOI":"10.1093\/cid\/ciae191"},{"key":"2025110923500699000_2025.11.05.25339607v1.6","unstructured":"Hales CM . Prevalence of Obesity and Severe Obesity Among Adults. 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