Abstract
BACKGROUND AND AIMS: In low- and middle-income countries, dolutegravir-based antiretroviral therapy regimens are the preferred first-line treatment for adults, adolescents, and children with human immunodeficiency virus (HIV). Dolutegravir exhibits a higher genetic barrier to resistance, improved tolerability, and reduced potential for drug-drug interactions. However, emerging reports suggest a possible association between dolutegravir usage and hyperglycemia. Therefore, this study aims to investigate the hyperglycemia risk in dolutegravir-based antiretroviral therapy among people living with HIV and tuberculosis (TB) in Zimbabwe. METHODS: An analytical cross-sectional study was conducted on 162 participants aged 18 and older, recruited from April to July 2024 in Harare, Zimbabwe. Participants were divided into three groups based on their HIV and TB status and dolutegravir dosage. Participants' glycated hemoglobin levels were analyzed to determine the hyperglycaemic risk. A questionnaire was also administered to assess the risk factors associated with hyperglycemia. The R statistical software (version 4.3.2, Vienna, Austria) was used for data analysis. A p-value of < 0.05 was considered to be statistically significant. RESULTS: The median (interquartile range) ages for these sub-groups were 44 [36-56], 44 (29.3-54.8), and 45 [35-56] years, respectively, and the age range was 20-80 years. The group taking 100 mg of dolutegravir had a 40% prevalence of impaired glucose regulation, and a hyperglycemia prevalence of 31%. In the multivariable logistic regression analysis, taking 100 mg of dolutegravir was associated with a 5.17 (95% Confidence Interval: 1.21-27.82) fold risk of developing hyperglycemia. CONCLUSION: The study findings indicate that the prevalence of hyperglycemia and impaired glucose regulation is high in patients taking dolutegravir-based antiretroviral therapy in Zimbabwe. People living with both HIV and TB taking a double dose of dolutegravir are at a higher risk of hyperglycemia and impaired glucose regulation than those taking lower doses. This emphasizes the necessity for clinical and public health interventions to mitigate this emerging hyperglycaemic risk.