ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2021
Risk of Incident Diabetes Mellitus, Weight Gain, and Their Relationships With Integrase Inhibitor-Based Initial Antiretroviral Therapy Among Persons With Human Immunodeficiency Virus in the United States and Canada.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 59 papers, 3 of them syntheses that pooled it.
What it found
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Who cites it
59 citing papers in PubMed, 3 syntheses or guidelines pooled it, 99 citations in OpenAlex.
- Diabetes risk in HIV infection and antiretroviral therapy: A systematic review and meta-analysis of prospective cohort evidence.HIV medicine · 2026Pooled it
- A systematic review of mediation analysis frameworks in studies examining the determinants of cardiometabolic outcomes in people living with HIV.BMC medical research methodology · 2025Pooled it
- Association between integrase strand transfer inhibitor use with insulin resistance and incident diabetes mellitus in persons living with HIV: a systematic review and meta-analysis.BMJ open diabetes research & care · 2023Pooled it
- A Randomized Trial to Compare Dolutegravir Plus Boosted Darunavir Versus Recommended Standard of Care Antiretroviral Regimens in People With HIV-1, Whose First-line Non-nucleoside Reverse Transcriptase Inhibitor Therapy Has Failed: Final 96-week Results of the D2EFT Study.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Trial
- Development of a heart failure with preserved ejection fraction risk prediction score in primary care settings with a high HIV prevalence.Open heart · 2026Observational
- The Triglyceride-Glucose (TyG) Index and Incident Diabetes and Cardiovascular Events in People Living With HIV-1 Infection. A 14-Year Observational Cohort Study.European journal of clinical investigation · 2026Observational
- A distinct form of fat fibrosis is linked to insulin resistance in people with HIV.JCI insight · 2026Observational
- Changes in weight and glycemia after initiation of integrase strand transfer inhibitors among people with HIV and diabetes.AIDS (London, England) · 2026Article
- Incident diabetes after switching to integrase strand transfer inhibitors in people with HIV in the USA and Canada: a cohort study.The lancet. HIV · 2026Article
- Pharmacovigilance study of INSTIs associated with weight gain and glucose/lipid metabolism adverse events based on the FDA adverse event reporting system.HIV medicine · 2026Article
- Metabolic syndrome and its risk factors among adults living with HIV receiving antiretroviral therapy in Zambia: an ambidirectional cohort study.Scientific reports · 2026Article
- Menopause is associated with faster increases in insulin resistance in women with HIV.AIDS (London, England) · 2026Article
- Virologic, immunologic, and metabolic outcomes and mortality in people with HIV on bictegravir/emtricitabine/tenofovir alafenamide fumarate versus dolutegravir-based antiretroviral therapies: a retrospective multicenter cohort study in China.The Lancet regional health. Western Pacific · 2026Article
- Longitudinal analysis of metabolic changes in people with HIV on integrase inhibitor-based versus efavirenz-based therapy: a prospective real-world cohort study in China.BMC infectious diseases · 2026Article
- Type 2 diabetes in people living with HIV: epidemiology, mechanisms, sex differences and early-life determinants.Frontiers in endocrinology · 2026Review
- Sexual orientation, gender identity and cardiometabolic risk: a narrative review.Diabetologia · 2025Review
- Hyperglycaemia and Its Risk Factors Among Adults Living With HIV on Follow-Up at the Hawassa City Administration, Southern Ethiopia: A Cross-Sectional Study.Endocrinology, diabetes & metabolism · 2025Article
- Integrase Strand Transfer Inhibitor-Related Changes in Body Mass Index and Risk of Diabetes: A Prospective Study From the RESPOND Cohort Consortium.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Article
- Efficacy and safety of doravirine/lamivudine/tenofovir disoproxil fumarate in HIV treatment: a real-world single-center study in China.Frontiers in medicine · 2025Article
- The Impact of Selected Regimens of Chronic HIV-Antiretroviral Treatment on Glycemic Control Markers and Correlates: A Systematic Review and Meta-Analysis Protocol.Health science reports · 2025Review
Corrections and comments
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Authors and funding
23 authors at 14 institutions in 3 countries.
Funding
Abstract
backgroundIntegrase strand transfer inhibitor (INSTI)-based combination antiretroviral therapy (cART) is associated with greater weight gain among persons with human immunodeficiency virus (HIV), though metabolic consequences, such as diabetes mellitus (DM), are unclear. We examined the impact of initial cART regimen and weight on incident DM in a large North American HIV cohort (NA-ACCORD).
methodscART-naive adults (≥18 years) initiating INSTI-, protease inhibitor (PI)-, or nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens from January 2007 through December 2017 who had weight measured 12 (±6) months after treatment initiation contributed time until clinical DM, virologic failure, cART regimen switch, administrative close, death, or loss to follow-up. Multivariable Cox regression yielded adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for incident DM by cART class. Mediation analyses, with 12-month weight as mediator, similarly adjusted for all covariates.
resultsAmong 22 884 eligible individuals, 47% started NNRTI-, 30% PI-, and 23% INSTI-based cART with median follow-up of 3.0, 2.3, and 1.6 years, respectively. Overall, 722 (3%) developed DM. Persons starting INSTIs vs NNRTIs had incident DM risk (HR, 1.17 [95% CI, .92-1.48]), similar to PI vs NNRTI initiators (HR, 1.27 [95% CI, 1.07-1.51]). This effect was most pronounced for raltegravir (HR, 1.42 [95% CI, 1.06-1.91]) vs NNRTI initiators. The INSTI-DM association was attenuated (HR, 1.03 [95% CI, .71-1.49] vs NNRTIs) when accounting for 12-month weight.
conclusionsInitiating first cART regimens with INSTIs or PIs vs NNRTIs may confer greater risk of DM, likely mediated through weight gain.
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