Dolutegravir-related hyperglycemia among children and adolescents <18 years in Northern and Eastern Uganda: A cross-sectional study

ABSTRACT Background The World Health Organization (WHO) recommended Dolutegravir (DTG) as the preferred anchor drug for first and second line Anti-Retroviral Treatment (ART) regimen. Case reports and studies have demonstrated new onset hyperglycemia among adults initiated or transitioned to DTG. There is paucity of data on DTG-related hyperglycemia among children and adolescents and subsequently, glycemic screening is not routinely conducted for those using DTG. We determined the prevalence and factors associated with DTG-related hyperglycemia in this age category. Methods This cross-sectional study was conducted from 28 th October 2022 to 11 th September 2023 at Soroti and Lira Regional Referral Hospitals. 251 children and adolescents under 18 years, on a DTG based ART regimen, were consecutively enrolled and data analyzed for 240 participants. Socio-demographic, anthropometric measurements, clinical, and laboratory variables were collected using a questionnaire. Random blood glucose testing, urine dipstick and HbA1c analyses were conducted. Data was entered into epiData version 4.6, cleaned, and analyzed using STATA version 17.0. Logistic regression was used to determine the relationship between outcome and predictor variables. A p-value < 0.05 was considered statistically significant at multivariate analysis. Results Of the 240 study participants, 55.4 %(n=133) were female and 71.7 %(n =172) were over 10 years. The prevalence of DTG-related-hyperglycemia was 20% (n=49) and 95.9% (n=47) met the criteria for pre-diabetes. Health education talks on Adverse events related to Dolutegravir was protective for hyperglycemia (aOR 0.4, 95% CI 0.2-0.9), p = 0.035. Conclusion The prevalence of DTG-related-hyperglycemia was high, occurring in every 2 in 10 children and adolescents. Health education talks on adverse events associated with DTG use were found to be protective against hyperglycemia. Routine glycemic screening and monitoring therefore should be emphasized. Additionally, a strategy for health education talks focusing on lifestyle modifications to reduce the occurrence of hyperglycemia should be developed.