Prevalence of and Factors Associated with Hypertension Among Adults on Dolutegravir-Based Antiretroviral Therapy in Uganda: A Cross Sectional Study

Abstract

Introduction

Dolutegravir-based anti-retroviral therapy (ART) regimens were rolled out as first line HIV treatment in Uganda due to their tolerability, efficacy and high resistance barrier to human immunodeficiency virus (HIV). They have however been associated with weight gain, dyslipidemia and hyperglycemia which are cardiometabolic risk factors of hypertension. We assessed the prevalence and factors associated with hypertension among adults on dolutegravir regimens.

Methods

We conducted a cross-sectional study on 430 systematically sampled adults on dolutegravir-based ART for ≥ 6 months. Hypertension was defined as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or history of use of antihypertensive agents.

Results

The prevalence of hypertension was 27.2% (117 of 430 participants) [95% CI: 23.2–31.6]. Majority were female (70.7%), the median age 42 [34, 50] years, with body mass index (BMI) ≥ 25 kg/m³ (59.6%) and median duration on DTG-based regimens of 28 [15, 33] months. Being male [aPR: 1.496, 95% CI: 1.122–1.994, P = 0.006], age ≥ 45 years [aPR: 4.23, 95% CI: 2.206–8.108, P < 0.001] and 35–44 years [aPR: 2.455, 95% CI: 1.216–4.947, P < 0.012] as compared with age < 35 years, BMI ≥ 25 kg/m³ [aPR: 1.489, 95% CI: 1.072–2.067, P = 0.017] as compared with BMI < 25 kg/m³, duration on dolutegravir-based ART [aPR: 1.008, 95% CI: 1.001–1.015, P = 0.037], family history of hypertension [aPR: 1.457, 95% CI: 1.064–1.995, P = 0.019] and history of heart disease [aPR: 1.73, 95% CI: 1.205–2.484, P = 0.003] were associated with hypertension.

Conclusion

One in every four people with HIV (PWH) on dolutegravir-based ART has hypertension. We recommend the integration of hypertension management in the HIV treatment package and policies to improve existing supply chains for low cost and high-quality hypertension medications.

Keywords:

• hypertension
• dolutegravir
• HIV

Patient and Public Involvement

Patients did not participate in any aspect of the research study such as design, methods, interpretation of findings or contribute to the writing of this paper.

Data Sharing Statement

The data from this study will be available on request to the corresponding author.

Ethics

The study was approved by Makerere University School of Medicine Research Ethics Committee (SOMREC) with approval number: MAK-SOMREC-2021-178. Mengo Hospital provided the administrative authorization. Informed consent was obtained from all eligible participants using an informed consent form by their signature or thumb–print while others were signed by a witness for those who could not read and write. This study complies with the Declaration of Helsinki.

Consent for Publication

All authors consented to have the manuscript with the attached documents published.

Acknowledgments

Study participants, Mengo Hospital administration and the CHCD staff, clinical epidemiology unit (CEU), supervisors; Professor Joan Kalyango (CEU director), Dr Achilles Katamba, Dr William Lumu, Edith Namulema and the MakNCD training programme for mentoring and funding the research and school.

Disclosure

There was no conflict of interest as declared by the authors.

Additional information

Funding

The study was supported by the Makerere University Non-Communicable Diseases (MAKNCD) Research Training Program: supported by the Fogarty International Centre of the National Institutes of Health under Award Number D43TW011401.The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Health.