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.