PROJECT SUMMARY & ABSTRACT Candidate. Dr. Puja Chebrolu is a physician-scientist who has spent the past five years conducting research on HIV and diabetes in India. She has conducted longitudinal research, developed strong scientific collaborations with Indian scientists, trained an Indian research team, and authored 10 publications. She has documented that HIV increases the risk of gestational diabetes (GDM). She hypothesizes that HIV will also increase the risk of prediabetes (preDM) and type 2 diabetes (T2DM) development postpartum. Career Development Plan. Dr. Chebrolu's immediate and long-term goals are the following: 1) Increase her understanding of HIV-associated diabetes epidemiology and pathogenesis. 2) Increase her skills in advanced biostatistics for longitudinal data 3) Obtain training in the conduct of clinical trials 4) Develop professional skills including leadership and mentorship Dr. Chebrolu will develop these skills through coursework and implementation of her longitudinal study on time course and predictors of progression to postpartum preDM and T2DM in women living with HIV and GDM. Environment. The proposed research and training will take place at Weill Cornell Medicine (USA) and at Byramjee Jeejeebhoy Government Medical College (India). Dr. Chebrolu's mentors have expertise that encompass her goals. They have worked with her and each other previously. Research. Over data two-thirds of women who develop GDM will progress to T2DM within 10 years. suggests that HIV doubles the risk of GDM Dr. Chebrolu's , and is associated with increased risk of progression to T2DM. The impact of HIV on postpartum progression to preDM and T2DM is not known. Preliminary data suggests that South Asian women progress to T2DM faster than obese populations due to low baseline pancreatic beta cell mass. HIV increases beta cell stress through multiple mechanisms and may further accelerate the rate of progression to T2DM. Understanding progression its the impact of HIV on the time course and pathophysiology of T2DM will help inform the timing and type of interventions to prevent or delay progression to T2DM and devastating sequelae. Aim 1: Estimate the time to progression to postpartum prediabetes and T2DM in 180 women with a history of GDM (60 women with HIV and 120 women without HIV). We will test for prediabetes and T2DM at 5 timepoints over 2 years postpartum. This aim will test the hypothesis that hazard of progression to prediabetes or T2DM will be significantly higher in women with GDM and HIV compared to women with GDM and without HIV. Aim 2: Determine the effect of HIV on longitudinal beta cell function in women with a history GDM. The primary hypothesis is that women with HIV and GDM will have a greater rate of decline in pancreatic beta cell function over 2 years postpartum compared to women with GDM and without HIV.