Effect of dolutegravir on plasma glucose among human immunodeficiency virus patients in a community health center setting

Abstract

Background: Dolutegravir has become one of the initial backbone in antiretroviral therapy (ART) regimens for most patients with human immunodeficiency virus (HIV) in several recent clinical guidelines. However, dolutegravir has been associated with severe cases of hyperglycemia and new-onset of diabetes in multiple case reports and clinical trials. A community health center noticed an increasing number of new-onset hyperglycemia incidences in patients on dolutegravir.Methods: Retrospective chart review of patients who started on dolutegravir or dolutegavir combination regimen (Triumreq®, Juluca®) between the dates of 1 January 2013 to 1 January 2018 who have been treated in community healthcare centers. Baseline blood sugar and/or A1C before starting dolutegravir, at 3-6 months of treatment and at end of study were compared between subjects.Results: 422 subjects were enrolled. Dolutegravir had little effect on plasma glucose among 72% of the subjects (n=305). However, 7% of the subjects (n=28) on dolutegravir treatment with no glucose intolerance met criteria for prediabetes at 3-6 months of therapy. One subjects had developed diabetes at 3-6 months after dolutegravir was initiated. In addition, at the end of the study, thirteen percent of patients developed prediabetes (n=56) and 1.4% developed diabetes (n=6). Among the 24 subjects that had diabetes before dolutegravir was initiation, 83% required intensification of their diabetes regimen.Conclusions: Dolutegravir may cause a moderate increase in plasma sugar after 3-6 months of therapy. Further increase has been noticed up to 12%. Due to existence of confounding variables, patient with diabetes should not be switched from dolutegravir.