Journal Article

Effect of Prior Exposure to Non-dolutegravir Antiretroviral Therapy on Hyperglycemia Among Adult Clients on Dolutegravir Based Regimens in Central Uganda

Agolor, C, Karamagi, Y, Mukasa, B, Nambasa, V N, Kasamba, I, Nakubulwa, S K, Odiit, M, Nakitto, D K, Namasambi, S, Mayengo, J M, Ndagije, H B, Ankunda, C, Mukama, C S

2023

Overview

Introduction: The use of Dolutegravir (DTG) expanded in Uganda since its introduction in 2020. Adverse effects of DTG use related to hyperglycemia are a concern(1). The risk of hyperglycemia and DM has not been fully characterized, especially in cohorts using DTG, nevertheless, there has been an effort to document and characterize events of symptomatic hyperglycemia following transition to DTG in Uganda(2). Aim: To evaluate whether prior exposure to non-DTG based ART backbone regimen influences the occurrence of hyperglycemia among patients receiving DTG-based ART regimens. Methods: A prospective cohort study among clients aged 18 years from July 2021 to September 2022 from urban and rural Mildmay Uganda study sites. Results: Overall, 628 participants currently on tenofovir, lamivudine and dolutegravir fixed dose combination (TLD)were enrolled. The overall incidence of hyperglycemia was 24.5 (95% CI 19.3-31.1) per 100 person-years. Sixty-eight cases (11%) of hyperglycemia were observed in a total of 277.4 years of observation. There was no statistical evidence to detect an association between previous exposure to non DTG based regimen and incidence of hyperglycemia in the population of clients on DTG. The following factors remained independently associated with hyperglycemia: the study site indicator (pvalue\\0.001), the duration on Dolutegravir-based ART regimens (pvalue = 0.02), age of the respondent (p-value\\0.001) and marital status (p-value = 0.06). Overall, 10% (n = 63) reported at least one adverse event at any point during follow-up. The most common adverse events were related to cardiovascular (24.4%), sexual dysfunction (19.5%), Central nervous system (14.6%), and neuropathies (9.8%). Conclusions: Prior exposure to non-DTG based ART regimens was associated with increased occurrence of glycaemia. It was noted that increasing age and duration of exposure to DTG based regimens was associated with an increased risk of hyperglycemia among PLHIV on TLD. The implication of the findings is that screening, care and treatment of hyperglycemia should be integrated into the existing HIV care and treatment services among clients transitioned or initiated on DTG based regimens. More follow up time was recommended to detect a difference in hyperglycemia incidence between new participants initiated on DTG and those initially initiated on other non-DTG ART regimen.

• Publisher: Springer Nature B.V
• Subject: Adverse events / Antiretroviral agents / Antiretroviral drugs / Antiretroviral therapy / Blood glucose / Central nervous system / Clients / Exposure / HIV / Human immunodeficiency virus / Hyperglycemia / Lamivudine / Neuropathy / Sexual behavior / Sexually transmitted diseases / STD / Tenofovir