Lillian Happy Byereta, Ronald Olum, Edrisa Ibrahim Mutebi, Robert Kalyesubula, Majid Kagimu, David B Meya, Irene Andia-Biraro
{"title":"Prevalence and factors associated with hyperglycemia among persons living with HIV/AIDS on dolutegravir-based antiretroviral therapy in Uganda.","authors":"Lillian Happy Byereta, Ronald Olum, Edrisa Ibrahim Mutebi, Robert Kalyesubula, Majid Kagimu, David B Meya, Irene Andia-Biraro","doi":"10.1177/20499361241272630","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>To determine the prevalence and factors associated with hyperglycemia among PLHIV receiving DTG-based ART at Kiruddu National Referral Hospital (KNRH), Uganda.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Methods: </strong>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<sup>®</sup> (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 <i>p</i> < 0.05.</p><p><strong>Results: </strong>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%, <i>n</i> = 232) and the majority (90%) had a CD4 count above 200 cells/µL. About 16% had a family history of diabetes, 11.73% (<i>n</i> = 46) showed elevated blood pressure levels, and 16.7% (<i>n</i> = 64) had obesity. Hyperglycemia was present in 12.8% (<i>n</i> = 51), with 10.3% having pre-diabetes (<i>n</i> = 41) and 2.5% with diabetes mellitus (<i>n</i> = 10). At bivariate analysis, hyperglycemia was significantly associated with age >40 years (<i>p</i> < 0.001), herbal medicine use (<i>p</i> = 0.03), being widowed (<i>p</i> < 0.001), obesity (<i>p</i> = 0.042), hypertension (<i>p</i> = 0.002) and >3 since diagnosis with HIV (<i>p</i> = 0.030). At multivariable regression, only age >40 (AOR 2.55, 95% CI: 1.05-6.23, <i>p</i> = 0.039) and hypertension (AOR 2.93, 95% CI: 1.07-8.02, <i>p</i> = 0.036) remained significantly associated with hyperglycemia.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":46154,"journal":{"name":"Therapeutic Advances in Infectious Disease","volume":null,"pages":null},"PeriodicalIF":3.8000,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11403689/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Therapeutic Advances in Infectious Disease","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/20499361241272630","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0
Abstract
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 p < 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%, n = 232) and the majority (90%) had a CD4 count above 200 cells/µL. About 16% had a family history of diabetes, 11.73% (n = 46) showed elevated blood pressure levels, and 16.7% (n = 64) had obesity. Hyperglycemia was present in 12.8% (n = 51), with 10.3% having pre-diabetes (n = 41) and 2.5% with diabetes mellitus (n = 10). At bivariate analysis, hyperglycemia was significantly associated with age >40 years (p < 0.001), herbal medicine use (p = 0.03), being widowed (p < 0.001), obesity (p = 0.042), hypertension (p = 0.002) and >3 since diagnosis with HIV (p = 0.030). At multivariable regression, only age >40 (AOR 2.55, 95% CI: 1.05-6.23, p = 0.039) and hypertension (AOR 2.93, 95% CI: 1.07-8.02, p = 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.