{"id":37218,"date":"2020-04-01T07:45:53","date_gmt":"2020-04-01T07:45:53","guid":{"rendered":"http:\/\/i-base.info\/htb\/?p=37218"},"modified":"2020-04-17T12:38:53","modified_gmt":"2020-04-17T12:38:53","slug":"dolutegravir-associated-with-hyperglycaemia-in-people-switching-first-line-art-in-uganda","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/37218","title":{"rendered":"Dolutegravir associated with hyperglycaemia in people switching first-line ART in Uganda"},"content":{"rendered":"

Polly Clayden, HIV i-Base<\/span><\/strong><\/p>\n

Hyperglycaemia was reported in Uganda among people switching first-line regimens to dolutegravir-based ART, in a letter to Lancet HIV, published online 24 February 2020.<\/span><\/b><\/p>\n

The authors recommend that a monitoring plan for hyperglycaemia should be part of the clinical care package for people switching ART to dolutegravir-based regimens. <\/span><\/p>\n

In March 2018, the Ugandan Government recommended dolutegravir-based ART for treatment-naive people with HIV and that eligible treatment-experienced patients be transitioned from their existing first-line regimens.<\/span><\/p>\n

This programme originally started in specialised centres \u2013 including the Infectious Diseases Institute at Makerere University (Kampala, Uganda). A year later, 3417\/6648 people on first-line regimens attending the facility had started dolutegravir. <\/span><\/p>\n

The authors noticed that some people developed symptomatic hyperglycaemia after switching to dolutegravir, so they documented these events. <\/span><\/p>\n

They compared cumulative incidence of symptomatic hyperglycaemia in people who started dolutegravir-based first-line regimens between 1 April 2018 and 31 March 2019 (cases), to that among all others on non-dolutegravir-based first-line regimens in the same period (controls). <\/span><\/p>\n

There was 12 months follow up starting from 1 May 2018. The authors noted that this month had the highest frequency of starting dolutegravir. <\/span><\/p>\n

The report revealed 16\/3417 (0\u00b747%) of people in the case group had new-onset hyperglycaemia vs 1\/3230 (0\u00b703%) in the control group (p=0\u00b70004). Over 12 months this gave an incidence of 4\u00b77 per 1000 vs 0\u00b732 per 1000, in the case and control group respectively.<\/span><\/p>\n

Among the cases, hyperglycaemia events were severe (in 15\/16) and the majority were preceded by weight loss after starting dolutegravir rather than weight gain.<\/span><\/p>\n

Median time from starting dolutegravir to onset of hyperglycaemia was 4 months (IQR 2\u00b75 to 4\u00b75). People \u00a0with hyperglycaemia were given antidiabetic medication and dolutegravir was stopped and substituted with an alternative antiretroviral. <\/span><\/p>\n

Two people in the case group who initially presented with grade 3 hyperglycaemia reversed this after stopping dolutegravir. One no longer needed metformin after 6 weeks and the other after 6 months. Currently both are able to control their diabetes with diet alone. <\/span><\/p>\n

The authors suggest that these findings could be subject to confounding: more people who transitioned to dolutegravir were older, male, or had been on ART for 5 years or more (p<0\u00b70001 for each) vs those who did not transition to dolutegravir. <\/span><\/p>\n

\u201cEarly recognition of potentially serious toxicities is crucial to inform the implementation of large-scale national ART programmes. This is especially true in settings in which pharmacovigilance systems are weak\u201d they wrote. And they recommend that people switching ART to dolutegravir-based regimens be monitored for hyperglycaemia. <\/span><\/p>\n

Reference<\/span><\/p>\n

Lamorde M et al. Dolutegravir-associated hyperglycaemia in patients with HIV. Lancet HIV 2020. \u00a0Published online 24 February 2020.
\n<\/span>https:\/\/www.thelancet.com\/journals\/lanhiv\/article\/PIIS2352-3018(20)30042-4\/fulltext<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Polly Clayden, HIV i-Base Hyperglycaemia was reported in Uganda among people switching first-line regimens to dolutegravir-based ART, in a letter to Lancet HIV, published online 24 February 2020. The authors recommend that a monitoring plan for hyperglycaemia should be part …<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8],"tags":[],"class_list":["post-37218","post","type-post","status-publish","format-standard","hentry","category-side-effects"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/37218","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=37218"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/37218\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=37218"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=37218"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=37218"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}