Incidence of type 2 diabetes mellitus in persons living with HIV initiated on dolutegravir-based antiretroviral regimen in Ghana: an observational longitudinal study.

Background: Few studies have reported hyperglycemia and diabetic ketoacidosis in patients on dolutegravir (DTG) treatment. This study determined the effect of DTG on fasting blood glucose levels in a cohort of persons living with HIV (PLHIV) in Ghana and initiating DTG regimens.

Methods: A two-year observational longitudinal cohort study conducted from 12th October 2020 to 31st December 2022. Fasting blood glucose was measured at baseline, 12, 24, 36 and 72 weeks for patients after a 12 h overnight fast. The Kaplan-Meier estimator was used to estimate the risk of developing type 2 diabetes mellitus (T2DM). Cox proportional hazard model was used in estimating hazard ratios.

Results: A total of 1334 non-diabetic patients were enrolled with 78% (1039) females and 83% (1104) were antiretroviral therapy experienced. The incidence proportion and rate of T2DM at 72 weeks were 11.8% (95%CI: 10.2-13.7) and 98.1 cases per 1000 PY (95%CI: 83.9-114.6) respectively. The median time to development of T2DM was 24 weeks post DTG initiation. Male sex (aHR 2.9 [95%CI: 1.9-4.3]), abnormal waist-hip ratio (1.67 [95% CI: 1.15-2.43]) and abnormal total serum cholesterol (aHR 1.6 [95%CI: 1.1-2.3]) were found to be significant determinants of T2DM.

Conclusion: Incidence of T2DM is high among non-diabetic PLHIV within 72 weeks of initiating DTG based therapy with males having a higher risk. Longitudinal changes in waist-hip ratio and serum cholesterol among patients initiated on DTG needs to be monitored regularly.