Incident diabetes in course of antiretroviral therapy

Objective: Recent reports of excessive weight gain in people with HIV (PWH) have raised increasing concerns on the possible increase of diabetes mellitus (DM) risk in course of integrase inhibitors (INSTIs) treatment. In this study, we aimed at describing DM incidence in course of antiretroviral therapy (ART) and identifying the factors associated with new DM onset. Design: Observational prospective SCOLTA (Surveillance Cohort Long-Term Toxicity Antiretrovirals) cohort. Methods: All people enrolled in SCOLTA between January 2003 and November 2021 were included. Multivariable Cox regression yielded adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for incident DM. Results: 4366 PWH were included, 72.6% male, with mean age 45.6 years, and median CD4 + 460 [interquartile range (IQR) 256–710] cells/mm 3 cells/mm 3 . During the follow up, 120 incident cases of DM occurred (1.26 cases/100 person year-follow up, 95% CI 1.05–1.50). Baseline weight, but not the amount of weight gain, resulted significantly correlated to diabetes incidence (aHR by 1 kg 1.03; 95% CI 1.01–1.04), as well as older age (aHR 1.03 by 1 year; 95% CI 1.01–1.06), being ART-experienced with detectable HIV RNA at study entry (aHR 2.27, 95% CI 1.48–3.49), having untreated high blood pressure (aHR 2.90; 95% CI 1.30–6.45) and baseline blood glucose >100 mg/dl (aHR 5.47; 95% CI 3.82–7.85). Neither the INSTI class nor individual antiretrovirals were associated with an increased risk of DM. Conclusions: Baseline weight, but not weight gain or the ART class, was associated with incident DM in this observational cohort.