Prevalence and factors associated with hyperglycemia among HIV infected Individuals on dolutegravir anti-retroviral therapy on Kiruddu National Referral Hospital.

Abstract

Background: Dolutegravir-based (DTG) regimens are rapidly replacing older antiretroviral therapy (ART) in low and middle-income countries as first line ART. DTG is preferred due to its efficacy, tolerability and cost-effectiveness. Some patients switched to dolutegravir are reported to have developed hyperglycemia, which causes endothelial damage resulting in micro and macro-vascular complications of diabetes mellitus. However, evaluation of blood glucose among HIV patients is not routinely done in most public health facilities due to high cost. Objectives: To determine the prevalence and factors associated with hyperglycemia among HIV positive individuals receiving DTG- based HIV Anti-retroviral therapy at Kiruddu National Referral Hospital. Methods: This was a cross-sectional study conducted at the in-patient wards and the communicable disease outpatient clinic of Kiruddu National Referral Hospital between May 2022 to July 2022 following ethical approval by the School of Medicine at Makerere University and Kiruddu Hospital. We consecutively recruited 398 eligible participants who gave informed consent. Data collection tools were used to collect information from patients. Data was cleaned, entered into Epi-Info, and exported to STATA 17 for analysis. Cross tabulations were done using Chisquare of Fischer’s exact test for categorical variables. Associations were analyzed using logistic regression models after adjusting for the necessary confounding co-variables and presented as crude and adjusted odd ratios with their 95% confidence intervals and corresponding p-values. Utility: Essentially to understand the magnitude of hyperglycemia in these settings and provide more generalizable scientific based evidence regarding the need for rigorous evaluation of blood glucose control in HIV positive patients after initiating DTG-based therapy in a public health setting and to provide data for future research on prevalence and factors associated with hyperglycemia for patients on DTG-based HIV ART in resource limited settings. Results:We enrolled 398 participants, 89.2% (n= 355) were outpatients and 10.8 % (n=43) were in-patients. Participants who were 18-40 years were 50% (199/398), 45.2% (180/398) between 41- 60 years, 4.8% (19/398) were over 60 years. median (interquartile range) age was 40.5 years (32-49) .58.3% (232/398) were female. 9.3% (37/398) were hypertensive. 10.3 % (41/398) had a CD4 count < 200 .16.7 % (64/398) had a BMI ≥30. The prevalence of hyperglycemia in this study was 13%. Factors associated for hyperglycemia included: age > 40 years AOR 2.55 (P= 0.039, 95% CI 1.05 – 6.23), being hypertensive AOR 2.93 (P=0.036, 95% CI 1.07 – 8.02). Conclusion: HIV positive patients receiving DTG based ART regimens are at increased risk of development of hyperglycemia. Risk factors for hyperglycemia should be identified and blood glucose monitored in all patients receiving DTG.