Ankunda Collins, Agolor Curthbert, Karamagi Yvonne, Nakubulwa Susan, Namasambi Sharon, Kasamba Ivan, Christopher Semei Mukama, Kukundakwe Patience, Odiit Mary, Mubangizi Ivan, Emunyu Jude, Kesi Diana Nakitto, Nambasa Victoria, Ndagije Helen Byomire, Mukasa Barbara
Mildmay Research Centre Uganda, Mildmay Uganda, Kampala, Uganda.
Directorate of Product Safety, National Drug Authority, Kampala, Uganda.
Open Forum Infect Dis. 2024 Oct 8;11(10):ofae596. doi: 10.1093/ofid/ofae596. eCollection 2024 Oct.
Dolutegravir (DTG), a key component of the recommended human immunodeficiency virus (HIV) treatment regimens in Uganda, has been associated with hyperglycemia. We evaluated its influence on hyperglycemia risk to create a hyperglycemia risk stratification tool for patient monitoring.
We conducted a prospective cohort study at 3 sites with 628 HIV-positive patients on tenofovir disoproxil fumarate, lamivudine, and dolutegravir (TLD). Participants included both nucleoside reverse transcriptase inhibitor-experienced (exposed) and antiretroviral therapy (ART)-naive (nonexposed) groups. Follow-up occurred every 6 months with random blood sugar (RBS) testing every 3 months. Participants with RBS ≥7 mmol/L were classified as hyperglycemic and underwent glycated hemoglobin (HbA1c) testing, confirming diabetes with a 6.5% cut-off.
The study found a hyperglycemia incidence rate of 24.5 (95% confidence interval [CI], 19.3-31.1) cases per 100 person-years (PY) and a diabetes incidence rate of 5.8 cases (95% CI, 3.6-9.3) per 100 PY. Hyperglycemia incidence was slightly lower in nonexposed (20.8 cases per 100 PY) versus exposed groups (25.2 cases per 100 PY). Multivariable analysis indicated a trend toward lower hyperglycemia risk (adjusted hazard ratio [aHR], 0.78 [95% CI, .37-1.66]; = .52) and substantially lower diabetes incidence (aHR, 0.34 [95% CI, .04-2.82]; = .32) in the nonexposed group. Significant factors for hyperglycemia included age ( < .001), study site ( < .001), and DTG-based ART duration ( = .02).
Our study showed an increased incidence of hyperglycemia with age, study site, and duration of DTG exposure in people with HIV on TLD. We suggest integrated screening and care for hyperglycemia and diabetes in HIV services, especially when initiating DTG regimens.
多替拉韦（DTG）是乌干达推荐的人类免疫缺陷病毒（HIV）治疗方案的关键组成部分，与高血糖有关。我们评估了其对高血糖风险的影响，以创建一个用于患者监测的高血糖风险分层工具。
我们在3个地点对628名接受替诺福韦酯、拉米夫定和多替拉韦（TLD）治疗的HIV阳性患者进行了一项前瞻性队列研究。参与者包括有核苷类逆转录酶抑制剂治疗经验（暴露）和未接受过抗逆转录病毒治疗（ART）（未暴露）两组。每6个月进行一次随访，每3个月检测一次随机血糖（RBS）。RBS≥7 mmol/L的参与者被分类为高血糖，并进行糖化血红蛋白（HbA1c）检测，以6.5%为切点确诊糖尿病。
研究发现高血糖发病率为每100人年24.5例（95%置信区间[CI]，19.3 - 31.1），糖尿病发病率为每100人年5.8例（95%CI，3.6 - 9.3）。未暴露组的高血糖发病率（每100人年20.8例）略低于暴露组（每100人年25.2例）。多变量分析表明，未暴露组高血糖风险有降低趋势（调整后风险比[aHR]，0.78 [95%CI，0.37 - 1.66]；P = 0.52），糖尿病发病率显著降低（aHR，0.34 [95%CI，0.04 - 2.82]；P = 0.32）。高血糖的显著因素包括年龄（P < 0.001）、研究地点（P < 0.001）和基于DTG的ART疗程（P = 0.02）。
我们的研究表明，接受TLD治疗的HIV感染者中，高血糖发病率随年龄、研究地点和DTG暴露时间增加。我们建议在HIV服务中对高血糖和糖尿病进行综合筛查和护理，尤其是在启动DTG治疗方案时。
