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Background Dolutegravir (DTG), a key component of the recommended human immunodeficiency virus (HIV) treatment regimens in Uganda, has been associated with hyperglycemia. We evaluated its influence on hyperglycemia risk to create a hyperglycemia risk stratification tool for patient monitoring. Methods We conducted a prospective cohort study at 3 sites with 628 HIV-positive patients on tenofovir disoproxil fumarate, lamivudine, and dolutegravir (TLD). Participants included both nucleoside reverse transcriptase inhibitor–experienced (exposed) and antiretroviral therapy (ART)–naive (nonexposed) groups. Follow-up occurred every 6 months with random blood sugar (RBS) testing every 3 months. Participants with RBS ≥7 mmol/L were classified as hyperglycemic and underwent glycated hemoglobin (HbA1c) testing, confirming diabetes with a 6.5% cut-off. Results The study found a hyperglycemia incidence rate of 24.5 (95% confidence interval [CI], 19.3–31.1) cases per 100 person-years (PY) and a diabetes incidence rate of 5.8 cases (95% CI, 3.6–9.3) per 100 PY. Hyperglycemia incidence was slightly lower in nonexposed (20.8 cases per 100 PY) versus exposed groups (25.2 cases per 100 PY). Multivariable analysis indicated a trend toward lower hyperglycemia risk (adjusted hazard ratio [aHR], 0.78 [95% CI,.37–1.66]; P =.52) and substantially lower diabetes incidence (aHR, 0.34 [95% CI,.04–2.82]; P =.32) in the nonexposed group. Significant factors for hyperglycemia included age (P <.001), study site (P <.001), and DTG-based ART duration (P =.02). Conclusions Our study showed an increased incidence of hyperglycemia with age, study site, and duration of DTG exposure in people with HIV on TLD. We suggest integrated screening and care for hyperglycemia and diabetes in HIV services, especially when initiating DTG regimens. [ABSTRACT FROM AUTHOR]

Background: People with disability are a vulnerable population and are at a high risk of acquiring human immunodeficiency virus (HIV) infection. Objectives: We investigated the association between severity of disability and not having knowledge of any HIV prevention method among adults in Uganda. Method: Between January 2015 and December 2015, data were collected within a general population in Uganda, on six domains of disability based on the Washington Group Short Set on Functioning. In addition, routine data on socio-demographic factors and other HIV-related data were collected among adults aged 16 years and above. A continuum of functioning was developed: without disability, mild, moderate and severe. Bivariate and multivariate associations of disability and not knowing any HIV prevention method were fitted using logistic regression models. Results: A total of 3331 adults (60.4% female) were included. Of these, 14.5% (n = 482) were classified as having either moderate or severe disability, and this proportion exponentially increased with age (p < 0.001). Overall, 4.2% (n = 140) reported not knowing any HIV prevention method, with a slightly higher proportion among females than males (3.1% in males, 4.9% in females). Compared to people with no disability, those with moderate or severe disability were 5 times more unlikely to know any HIV prevention methods (adjusted odds ratio = 5.45, 95% confidence interval = 3.25–9.13, p < 0.001). Additionally, the combined effect of moderate and severe disability and none/incomplete primary education increased the likelihood of not knowing HIV prevention methods over and beyond their separate effects (p < 0.001). Conclusion: Effective HIV prevention strategies must integrate best practices that target people with disabilities. Contribution: These findings contribute to the evidence of the lack of HIV prevention knowledge among people with disabilities in general populations. [ABSTRACT FROM AUTHOR]

Background: Antiretroviral therapy (ART) improves the survival and quality of life of HIV-positive individuals, but the effects of long-term ART use do eventually manifest. The Complications of Long-Term Antiretroviral Therapy cohort study in Uganda (CoLTART) was established to investigate the metabolic and renal complications of long-term ART use among Ugandan adults. We describe the CoLTART study set-up, aims, objectives, study methods, and also report some preliminary cross-sectional study enrolment metabolic and renal complications data analysis results. Methods: HIV-positive ART naive and experienced adults (18 years and above) in Uganda were enrolled. Data on demographic, dietary, medical, social economic and behaviour was obtained; and biophysical measurements and a clinical examination were undertaken. We measured: fasting glucose and lipid profiles, renal and liver function tests, full blood counts, immunology, virology and HIV drug resistance testing. Plasma samples were stored for future studies. Results: Between July 2013 and October 2014, we enrolled 1095 individuals, of whom 964 (88.0%) were ART experienced (6 months or more), with a median of 9.4 years (IQR 7.0-9.9) on ART. Overall, 968 (88.4%) were aged 35 years and above, 711 (64.9%) were females, 608 (59.6%) were or had ever been on a Tenofovir ART regimen and 236 (23.1%) on a Protease Inhibitor (PI) regimen. There were no differences in renal dysfunction between patients on Tenofovir and Non-Tenofovir containing ART regimens. Patients on PI regimens had higher total cholesterol, lower high density lipoprotein, higher low density lipoprotein, higher triglycerides, and a high atherogenic index for plasma than the non-PI regimen, p = 0.001 or < 0.001. Patients on Non-PI regimens had higher mean diastolic hypertension than patients on PI regimens, p < 0.001. Conclusions: Our finding of no differences in renal dysfunction between patients on Tenofovir and those on Non-Tenofovir containing ART regimens means that Tenofovir based first line ART can safely be initiated even in settings without routine renal function monitoring. However, integration of cardiovascular risk assessment, preventive and curative measures against cardiovascular disease are required. The CoLTART cohort is a good platform to investigate the complications of long-term ART use in Uganda. [ABSTRACT FROM AUTHOR]

Background: HIV care programs in resource-limited settings have hitherto concentrated on antiretroviral therapy (ART) access, but HIV drug resistance is emerging. In a cross-sectional study of HIV-positive adults on ART for =6 months enrolled into a prospective cohort in Uganda, plasma HIV RNA was measured and genotyped if =1000 copies/ml. Identified Drug resistance mutations (DRMs) were interpreted using the Stanford database, 2009 WHO list of DRMs and the IAS 2014 update on DRMs, and examined and tabulated by ART drug classes. Findings: Between July 2013 and August 2014, 953 individuals were enrolled, 119 (12.5%) had HIV-RNA =1000 copies/ml and 110 were successfully genotyped; 74 (67.3%) were on first-line and 36 (32.7%) on second-line ART regimens. The predominant HIV-1 subtypes were D (34.5%), A (33.6%) and Recombinant forms (21.8%). The commonest clinically significant major resistance mutations associated with the highest levels of reduced susceptibility or virological response to the relevant Nucleoside Reverse Transcriptase Inhibitor (NRTI) were; the Non-thymidine analogue mutations (Non-TAMS) M184V--20.7% and K65R--8.0%; and the TAMs M41L and K70R (both 8.0%). The major Non-NRTI (NNRTI) mutations were K103N--19.0%, G190A--7.0% and Y181C--6.0%. A relatively nonpolymorphic accessory mutation A98G--12.0% was also common. Seven of the 36 patients on second line ART had major Protease Inhibitor (PI) associated DRMS including; V82A--7.0%, I54V, M46I and L33I (all 5.0%). Also common were the accessory PI mutations L10I--27%, L10V--12.0% and L10F--5.0% that either reduce PI susceptibility or increase the replication of viruses containing PI-resistance mutations. Of the 7 patients with major PI DRMs, five had high level resistance to ritonavir boosted Lopinavir and Atazanavir, with Darunavir as the only susceptible PI tested. Conclusions: In resource-limited settings, HIV care programs that have previously concentrated on ART access, should now consider availing access to routine HIV viral load monitoring, targeted HIV drug resistance testing and availability of third-line ART regimens. [ABSTRACT FROM AUTHOR]