Relationship between hyperglycemia and dolutegravir based HAART and the associated factors at Mbale regional referral hospital: A case-control study.

Abstract

Background: In Uganda, the current 2018 HIV treatment guidelines recommend Dolutegravir(DTG)-based therapy as the first line antiretroviral therapy(ART) instead of Efavirenz(EFV)-based therapy due to its better safety and effectiveness. To the same regard, 280,000 people were switched to the new DTG-based therapy. However, DTG presented the highest cases of adverse effects reported to National Drug Authority (NDA) and chief among them was hyperglycemia. The main objective of the study was to establish the relationship between dolutegravir and hyperglycemia in HIV patients and the associated factors at Mbale Regional Referral Hospital, in Uganda. Methods We carried out a case control study on the files of HIV patients at Mbale regional referral Hospital. Cases were files with a diagnosis of hyperglycemia in the past 12 months and controls were those without a past medical history of hyperglycemia. We used purposive sampling for the cases and consecutive sampling for the controls. We reviewed a total of 148 files of which 37(25%) were cases. We used SPSS version 23 for statistical analysis where we obtained odds ratios, upon both bivariate and multivariate association of factors with hyperglycemia using logistic regression. We compared two multivariate models after exclusion and inclusion of DTG HAART. Results From the multivariate model, DTG exposure was significantly associated associated with development of hyperglycemia(OR=4.842; R2=33.302%; 95%CI, 1.540-15.423%; p=0.008). Inclusion of DTG improved on the overall accuracy of the multivariate model from 76.4 to 77.0%. Increase in age(OR=1.062; R2=33.302%; 95%CI=1.025-1.101%; P=0.001) and male gender (OR=2.751; R2=33.302%; 95%CI=1.169-6.474%; P=0.021) showed significant association with development of hyperglycemia in the multivariate model. Conclusions. DTG based HAART showed a stronger association to development of hyperglycemia among PLHIV, compared with other HAART regimens. Advancement in age, and male gender are significantly associated with development of hyperglycemia among the PLHIV on DTG based HAART.