Abstract
Integrase Strand Transfer Inhibitors (INSTIs) are globally used as first-line therapy for patients with HIV naïve to antiretroviral therapy (ART). However, INSTIs are associated with weight gain, raising concerns about metabolic complications. This retrospective cohort study aimed to determine the impact of INSTI therapy on the onset of diabetes mellitus (DM) in patients with HIV naïve to ART, initiating an INSTI-based regimen, from January 2011 to January 2023. The primary outcome was to determine DM incidence whereas secondary outcomes included evaluating the association between DM onset with weight gain and other cardiometabolic parameters and also establishing predictors of DM. The Kaplan-Meier method and Cox regression adjusted for age, CD4 T-cell count, and body mass index (BMI) were performed. Of the 352 patients included in our study, 30 developed DM, with an incidence rate of 24.6/1000 person-years. The greater median change in fasting blood glucose occurred at 3 years. The cumulative incidence of DM was 6.7% within the first 3 years, attaining 11.7% at 5 years. Patients receiving a dolutegravir-based regimen had a significantly lower DM incidence (p = 0.0031). Cox regression identified older age (adjusted HR 1.07; 95% CI 1.03-1.12; p < 0.001) and higher BMI (adjusted HR 1.15; 95% CI 1.04-1.34; p = 0.008) as independent predictors of DM. This study highlights the importance of glycaemic vigilance in patients with HIV initiating INSTI therapy, reinforces the need for tailoring screening strategies and contributes to the emerging understanding of long-term metabolic effects of these regimens in HIV management.