Hyperglycemia and its associated factors among adults living with HIV on dolutegravir-based antiretroviral therapy in East Africa: a systematic review and meta-analysis

Dolutegravir (DTG)-based antiretroviral therapy (ART) is the global first-line treatment for human immunodeficiency virus (HIV) due to its high efficacy and resistance barrier. However, emerging evidence suggests an association between DTG and metabolic complications, particularly hyperglycemia. Thus, this study aimed to estimate the prevalence of hyperglycemia with associated factors among adults living with HIV on DTG-based ART in East Africa. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. PubMed, Google Scholar, Science Direct, AJOL, and the Cochrane Library databases were used to search observational studies published until February 2026. The pooled prevalence was estimated using a random-effects model. Heterogeneity was assessed using the I² statistic, and publication bias was evaluated using Egger’s test. STATA version 18 0.1 was used for statistical analysis. A total of 12 studies involving 3,552 participants were included. The pooled prevalence of hyperglycemia among patients on DTG-based ART was 21.54% (95% CI: 15.16–28.74) with substantial heterogeneity (I 2 = 96.1%; p < 0.0001). Country-specific subgroup analysis showed the highest pooled prevalence in Ethiopia 20.41% (95% CI: 13.16–27.66) and the lowest in Uganda 15.05% (95% CI: 11.69–18.41). No publication bias was detected, and sensitivity analysis confirmed the robustness of the findings. Overweight (OR = 7.30, 95% CI: 1.02–52.33), family history of diabetes (OR = 1.59, 95% CI: 1.13–2.25), elevated total cholesterol (≥ 200 mg/dl; OR = 2.12, 95% CI: 1.32–3.39), and physical inactivity (OR = 1.67, 95% CI: 1.15–2.44) were significantly associated with hyperglycemia among people receiving dolutegravir-based therapy. The prevalence of hyperglycemia among adults receiving dolutegravir-based ART in East Africa was substantial, affecting approximately one in five individuals. Overweight, family history of diabetes, elevated total cholesterol, and physical inactivity were significantly associated with hyperglycemia. Routine monitoring of blood glucose and metabolic factors may facilitate early identification of hyperglycemia, particularly in settings with limited pharmacovigilance capacity.