Prevalence of Dolutegravir Associated Hyperglycemia and Its Covariates Among Persons Living With Hiv on Treatment at Kenyatta National Hospital
Abstract
Background
The introduction of dolutegravir based antiretroviral therapy has provided a potent
treatment option for persons living with the human immunodeficiency virus. However,
there is growing evidence from clinical settings that use of dolutegravir can result in
significant hyperglycemia. The prevalence of dolutegravir-associated hyperglycemia in
our population remains unknown. Identification of dolutegravir-associated hyperglycemia
is necessary for reducing morbidity and mortality associated with uncontrolled plasma
glucose levels among patients on antiretroviral therapy.
Objective
To determine the prevalence of dolutegravir associated hyperglycemia and its covariates
among adult persons living with human immunodeficiency virus on treatment and
follow-up at Kenyatta National Hospital.
Methodology
A cross-sectional descriptive study was conducted at Kenyatta National Hospital
comprehensive care center from July through to September, 2020. The study targeted
adult persons (>18 years) on dolutegravir-based antiretroviral therapy for at least 3
months. Pregnant mothers, diabetics or patients with a documented diagnosis of diabetes
were excluded from the study. Consecutive sampling technique was used to obtain a
representative sample of 358 participants, who consented to the study. Data on
prevalence of dolutegravir associated hyperglycemia and its covariates was collected
using laboratory measurements of random blood sugar and glycated hemoglobin levels.
Researcher administered structured questionnaires and IQ-care patient data base were
also used to obtain other information relevant to the objective of the study.
The main study outcome was hyperglycemia. A case/ non-case method was employed to
calculate the prevalence of dolutegravir-associated hyperglycemia and results presented
in frequency tables, and bar charts.
Logistic regression analysis was conducted to establish variables that were independently
associated with hyperglycemia development in this population. A p-value of < 0.05 was
considered statistically significant.
Results
The population studied was largely female (62%). The mean age of participants was 43.7
(SD 10.6) years. More than half of the population were in the middle-age bracket (41-60
years, 63.6%). Hyperglycemia was observed in 200 (55.9%), measured via glycated
hemoglobin and/or random blood sugar. On bivariate analysis advanced age (OR=1.7;
95% CI, 1.1 – 2.7); female gender (OR= 1.6; 95% CI, 1.1 – 2.5), overweight (OR= 1.8;
95% CI, 1.1 – 2.9) and obesity (OR= 3.1; 95% CI, 1.7 – 5.6) were found to be associated
with hyperglycemia development in this study population. However, on multivariate
analysis, only age >40 years, overweight and obesity were significantly associated with
development of hyperglycemia (aOR=1.7; 95% CI, 1.1 – 2.7; p= 0.026), (aOR=1.7; 95%
CI, 1.1 – 2.8; p = 0.026) and (aOR=3.1; 95% CI, 1.7 – 5.5; p<0.001), respectively.
Conclusion
The study showed a consistent hyperglycemic risk for patients on dolutegravir and
confirmed the usefulness and safety of glucose monitoring plan for patients on
dolutegravir. Early diagnosis of dolutegravir associated hyperglycemia is important in
providing optimal effective treatment while preventing complications for patients on
antiretroviral therapy. The study has also highlighted the importance of routine body
weight monitoring for all patients on dolutegravir.
Publisher
University of Nairobi
Rights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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