Changes in insulin kinetics in HIV infected patients diagnosed with dolutegravir associated diabetes in Uganda

Award amount: 30,000.00

There has been improved survival of HIV patients globally and very importantly in sub-Saharan Africa where the HIV incidence and prevalence is notably high. This could be attributed to the scale up of anti-retroviral therapy (ART) programs and improved ART efficacy and tolerability over time. With aging and cumulative side effects of ART, the burden of non-communicable diseases (NCDs) in people living with HIV (PLHIV) has been on the rise. As compared to infectious diseases, more resources are needed to diagnose and treat NCDS, a fact that underscores the need for improved prevention and surveillance more so in resource limited settings. The World Health Organization (WHO) in 2016 included dolutegravir (DTG) as an alternative first line regimen and later second line in 2018 after multiple studies demonstrated that it had enhanced efficacy, a higher genetic barrier to resistance, a good side effect profile and less drug- drug interactions. Despite the good side effect profile, DTG has been linked with incident hyperglycemia and worsening hyperglycemia in patients with diabetes. This is likely to compound the already increasing burden of NCDs in PLHIV. Whether it is pancreatic beta cell failure, progressively worsening insulin resistance or both that drives the onset of hyperglycemia in these patients remains to be demonstrated. It is also still unclear whether these patients revert back to their pre-diabetic glucose metabolic state after DTG substitution.