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Abstract Dolutegravir (DTG), a key component of the recommended HIV treatment regimens in Uganda, has been associated with hyperglycemia. We evaluated its influence on hyperglycemia risk to create a hyperglycemia risk stratification tool to guide patients’ monitoring. We conducted a prospective cohort study at three selected sites, involving 628 HIV patients who had been on Tenofovir Disoproxyl Fumarate, Lamivudine, and Dolutegravir (TLD). Patients were divided into those with prior Nucleoside reverse transcriptase inhibitors treatment (exposed) and antiretroviral therapy (ART) naïve individuals starting TLD (non-exposed). Patients had six-month follow-ups with Random Blood Sugar (RBS) draws every three months. Hyperglycemia was defined as RBS ≥ 7 mmol/L, and diabetes mellitus as RBS ≥ 7 mmol/L plus HbA1c ≥ 6.5%. The study observed a hyperglycemia incidence rate of 24.5 cases per 100 person-years (95% CI: 19.3–31.1) and a diabetes incidence rate of 5.8 cases per 100 person-years (95% CI: 3.6–9.3). The incidence of hyperglycemia was slightly lower in the non-exposed group (20.8 cases per 100 person-years) compared to the exposed group (25.2 cases per 100 person-years). The multivariable analysis suggested a trend towards a lower risk of hyperglycemia in the non-exposed group (adjusted HR = 0.78, 95% CI: 0.37–1.66, p = 0.52); and a trend towards a substantially lower diabetes incidence in the non-exposed group compared to the exposed (adjusted HR = 0.34, 95% CI: 0.04–2.82, p = 0.32). The study identified age (p < 0.001), study site (p < 0.001), and duration of DTG-based ART (p = 0.02) as significant factors associated with hyperglycemia. Our study showed an increased incidence of Hyperglycemia with age, study site, and duration of DTG exposure in HIV patients on TLD. No association was observed with exposure to non-DTG regimens. We suggest integrated screening and care for hyperglycemia and diabetes in HIV services, especially when initiating DTG-based regimens.
Ankunda et al. (Mon,) studied this question.