Abstract / Summary
Abstract Background Managing both HIV and type 2 diabetes is increasingly challenging in Uganda. At Lira Regional Referral Hospital, diabetic patients are often switched from dolutegravir (DTG)-based treatments to other regimens like TDF/3TC/EFV, PI-based, or ABC-based therapies. However, the metabolic effects of these non-DTG regimens have not been well documented. This study seeks to evaluate glycemic control and metabolic parameters in HIV-positive diabetic patients on different non-DTG ART regimens. Methods This cross-sectional study involved 54 HIV-positive adults with type 2 diabetes who had been on ART and hypoglycemic medications for at least 6 months at the Chronic Care Clinic of Lira Regional Referral Hospital. Data were gathered from medical records, and blood samples were taken to measure HbA1c, liver and kidney function tests, lipid profiles, and CD4 counts. Viral load data were retrieved from patient records. Participants were divided into six groups based on their ART and hypoglycemic treatment combinations. Data analysis included descriptive statistics and one-way ANOVA. Results All participants had documented suppressed viral load and CD4 counts above 350 cells/mm³, with a mean CD4 of 518.5 ± 56.8 cells/mm³. The average age was 54.8 ± 9.5 years, and 70.4% were female. HbA1c levels varied among the groups: the lowest was in Group 1 (TDF/3TC/EFV + metformin alone, n = 23) at 7.81%, followed by Group 6 (ABC/3TC/EFV without insulin or PI, n = 4) at 8.50%, Group 5 (PI-based without insulin, n = 5) at 8.94%, Group 2 (TDF/3TC/EFV + metformin + glibenclamide, n = 8) at 9.43%, Group 3 (TDF/3TC/EFV + insulin, n = 10) at 9.47%, and Group 4 (other HAART + insulin, n = 4) at 11.08%. One-way ANOVA revealed a significant difference in HbA1c across groups (F = 3.794, p = 0.006). Post-hoc tests showed that Group 1 had significantly lower HbA1c than Group 4, with a mean difference of 3.27% ( p = 0.014). ALP was elevated (> 120 U/L) across all groups, with the highest levels in insulin-containing groups. GGT elevation (40–60 U/L) was observed in Groups 1 and 3. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) remained within normal ranges across all groups, with mean ALT of 21.7 ± 12.5 U/L and mean AST of 20.5 ± 5.8 U/L. Elevated total cholesterol and triglycerides were observed only in Group 3 (TDF/3TC/EFV + insulin). Estimated glomerular filtration rate (eGFR) calculated using the CKD-EPI 2021 formula was 97.5 ± 14.8 mL/min/1.73 m², confirming preserved renal function. These findings align with clinical practice, where more severe diabetes cases are treated with insulin or additional medications. Conclusions Patients at this facility on non-DTG regimens who used TDF/3TC/EFV combined with metformin alone showed improved glycemic control, likely reflecting less severe initial diabetes. This study offers baseline descriptive data on metabolic outcomes within this group and underscores the necessity for prospective studies to examine the practice of switching diabetic patients away from DTG.