Prevalence and factors associated with hyperglycemia among persons living with HIV/AIDS on dolutegravir-based antiretroviral therapy in Uganda.

BACKGROUND

Dolutegravir-based (DTG) regimens are rapidly becoming the preferred first-line antiretroviral therapy (ART) for people living with HIV (PLHIV) in low and middle-income countries. However, there are rising concerns over the development of hyperglycemia and, in some cases, diabetes mellitus in patients switched to DTG.

OBJECTIVES

To determine the prevalence and factors associated with hyperglycemia among PLHIV receiving DTG-based ART at Kiruddu National Referral Hospital (KNRH), Uganda.

DESIGN

Cross-sectional study.

METHODS

The study was conducted in the inpatient wards and the infectious disease outpatient clinic of KNRH from May to July 2022. Participants aged ⩾18 years on a DTG-based ART regimen for at least 3 months were consecutively enrolled and interviewed using a research assistant administered questionnaire for sociodemographic and clinical characteristics. HbA1c was measured using whole blood Architect Ci4100 (Abbott, Illinois, USA), with hyperglycemia defined using a cut-off of ⩾5.7% as per the Uganda Diabetes Association guidelines. Factors associated with hyperglycemia were examined through logistic regression, adjusting for pertinent confounders, in STATA 17. A significance level was set at  < 0.05.

RESULTS

A total of 398 PLHIV with a median age of 40.5 years (IQR: 32-49) were enrolled. More than half were females (58.3%,  = 232) and the majority (90%) had a CD4 count above 200 cells/µL. About 16% had a family history of diabetes, 11.73% ( = 46) showed elevated blood pressure levels, and 16.7% ( = 64) had obesity. Hyperglycemia was present in 12.8% ( = 51), with 10.3% having pre-diabetes ( = 41) and 2.5% with diabetes mellitus ( = 10). At bivariate analysis, hyperglycemia was significantly associated with age >40 years ( < 0.001), herbal medicine use ( = 0.03), being widowed ( < 0.001), obesity ( = 0.042), hypertension ( = 0.002) and >3 since diagnosis with HIV ( = 0.030). At multivariable regression, only age >40 (AOR 2.55, 95% CI: 1.05-6.23,  = 0.039) and hypertension (AOR 2.93, 95% CI: 1.07-8.02,  = 0.036) remained significantly associated with hyperglycemia.

CONCLUSION

More than 1 in 10 patients on DTG-based ART in our study had hyperglycemia. We recommend regular monitoring of plasma glucose, especially for patients >40 years old and those with other comorbidities, before starting/switching to DTG regimens. Longitudinal studies are recommended to determine the underlying mechanisms of hyperglycemia in this population.