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

IF 3.8 Q2 INFECTIOUS DISEASES Therapeutic Advances in Infectious Disease Pub Date : 2024-09-10 eCollection Date: 2024-01-01 DOI:10.1177/20499361241272630
Lillian Happy Byereta, Ronald Olum, Edrisa Ibrahim Mutebi, Robert Kalyesubula, Majid Kagimu, David B Meya, Irene Andia-Biraro
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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.

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乌干达接受基于多罗替拉韦的抗逆转录病毒疗法的艾滋病毒/艾滋病感染者中的高血糖患病率及其相关因素。
背景:在低收入和中等收入国家,基于多罗替拉韦(DTG)的治疗方案正迅速成为艾滋病病毒感染者(PLHIV)首选的一线抗逆转录病毒疗法(ART)。然而,人们对改用 DTG 治疗的患者出现高血糖以及在某些情况下出现糖尿病的担忧与日俱增:确定在乌干达基鲁杜国家转诊医院(Kiruddu National Referral Hospital,KNRH)接受以 DTG 为基础的抗逆转录病毒疗法的 PLHIV 中,高血糖症的发生率及其相关因素:设计:横断面研究:研究于 2022 年 5 月至 7 月在 KNRH 的住院病房和传染病门诊进行。连续招募年龄在18岁以上、接受基于DTG的抗逆转录病毒疗法至少3个月的参与者,并使用研究助理发放的问卷调查他们的社会人口学和临床特征。HbA1c 使用全血 Architect Ci4100®(雅培,美国伊利诺伊州)进行测量,根据乌干达糖尿病协会指南,高血糖的临界值为 ⩾5.7%。与高血糖相关的因素在 STATA 17 中进行了逻辑回归分析,并对相关混杂因素进行了调整。显著性水平设定为 p 结果:共有 398 名艾滋病毒感染者参加了调查,他们的中位年龄为 40.5 岁(IQR:32-49)。半数以上为女性(58.3%,n = 232),大多数(90%)的 CD4 细胞计数高于 200 cells/µL。约 16% 的人有糖尿病家族史,11.73%(n = 46)的人血压升高,16.7%(n = 64)的人肥胖。12.8%(n = 51)的人患有高血糖,10.3%的人患有糖尿病前期(n = 41),2.5%的人患有糖尿病(n = 10)。在二元分析中,高血糖与年龄大于 40 岁(p p = 0.03)、丧偶(p p = 0.042)、高血压(p = 0.002)和确诊感染艾滋病毒后大于 3 次(p = 0.030)明显相关。在多变量回归中,只有年龄大于 40 岁(AOR 2.55,95% CI:1.05-6.23,p = 0.039)和高血压(AOR 2.93,95% CI:1.07-8.02,p = 0.036)仍与高血糖显著相关:结论:在我们的研究中,每 10 名接受以 DTG 为基础的抗逆转录病毒疗法的患者中就有超过 1 人患有高血糖。我们建议定期监测血糖,尤其是年龄大于 40 岁和患有其他合并症的患者,然后再开始/转用 DTG 治疗方案。建议进行纵向研究,以确定该人群高血糖的潜在机制。
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来源期刊
CiteScore
5.30
自引率
8.80%
发文量
64
审稿时长
9 weeks
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