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J Acquir Immune Defic Syndr. 2016 Oct 1;73(2):228-36. doi: 10.1097/QAI.0000000000001071.

Weight Gain and Incident Diabetes Among HIV-Infected Veterans Initiating Antiretroviral Therapy Compared With Uninfected Individuals.

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*Internal Medicine, VA Connecticut Healthcare System, West Haven, CT; †Internal Medicine, Yale University School of Medicine, New Haven, CT; ‡Department of Internal Medicine and General Internal Medicine, VA Connecticut Healthcare System, West Haven, CT; §Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; ‖Infectious Diseases, University of Pittsburgh School of Medicine, Doha, Qatar; ¶Infectious Diseases, VA Pittsburgh Healthcare System, Pittsburgh, PA; #Hamad Medical Corporation, Doha, Qatar; **Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, WA; ††Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, TN; ‡‡Internal Medicine/Infectious Diseases, School of Medicine and Health Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC; §§Internal Medicine/Infectious Diseases, Medical Service/Infectious Diseases, Veterans Affairs Medical Center, Washington, DC; ‖‖Infectious Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA; ¶¶Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, Los Angeles, CA; ##Infectious Diseases, VA Medical Center, Atlanta, GA; ***Infectious Diseases, Emory University School of Medicine, Atlanta, GA; †††Infectious Diseases Section, Michael E. DeBakey Veterans Affairs (VA) Medical Center; ‡‡‡Department of Medicine, Baylor College of Medicine, Houston, TX; §§§Immunology, Endocrinology, Yale Diabetes Center, Yale University School of Medicine, New Haven, CT; ‖‖‖Internal Medicine, Yale University School of Medicine and Public Health, New Haven, CT.



The health implications of weight gain after antiretroviral therapy (ART) for HIV infection are not well characterized and may differ from weight gain among uninfected individuals. We use data from the Veterans Aging Cohort Study to determine whether weight gain after ART has a similar association with incident type 2 diabetes mellitus (DM) as weight gained among HIV-uninfected (uninfected) individuals.


We explored associations of weight gain and incident diabetes (A1c ≥ 6.5%), in the Veterans Aging Cohort Study, a national observational study of HIV-infected (HIV+) individuals demographically matched 1:2 to uninfected controls. From 2000 to 2011, weight change was assessed in the year following ART initiation for HIV+ individuals and date of first available body mass index for uninfected individuals. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for baseline body mass index using Cox regression.


HIV+ individuals had lower prevalence of DM at baseline (12% HIV+, 23% uninfected) and lower incident diabetes (5% HIV+, 11% uninfected). The association of weight gain with risk of DM was linear for HIV+ and uninfected but the slope of the association was steeper for HIV+. For each 5 pounds of weight gained, HIV+ had 14% increased risk of DM (HR, 1.14; 95% CI: 1.10 to 1.17) and uninfected individuals had 8% increased risk (HR, 1.08; 95% CI: 1.07 to 1.10) (P < 0.01 for interaction).


Weight gained in the first year after ART initiation is associated with greater risk of DM than that among uninfected individuals. HIV+ individuals initiating ART who are not underweight should avoid substantial weight gain.

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