AI Insight
This cross-sectional study of 171 HIV-positive Zimbabwean adults on dolutegravir-based antiretroviral therapy found that 74.3% had dyslipidaemia and 13.4% had hyperglycaemia, with over half being overweight or obese and nearly 40% hypertensive. Low HDL cholesterol was the most common lipid abnormality (50.5%), and multivariate analysis identified increasing age as independently associated with hyperglycaemia and elevated blood pressure with dyslipidaemia. The findings suggest a substantial cardiometabolic disease burden in this population receiving what is now the globally preferred first-line HIV treatment.
Why it matters
As dolutegravir-based therapy becomes the standard treatment for HIV worldwide, these results highlight the need for integrated metabolic screening in HIV care programs, particularly in resource-limited settings like Zimbabwe where cardiovascular disease risk may be underrecognized. Early detection and management of these metabolic complications could prevent long-term cardiovascular events and diabetes in an aging HIV-positive population on lifelong antiretroviral therapy.
Understand the Science
by Ratidzo Chirimo, Danai Tavonga Zhou, Tinashe Mudzviti, Ian Machingura Ruredzo, Justen Manasa, Charles Chiedza Maponga, Zvenyika Alfred Reginald Gomo, Exnevia Gomo, Gene D. Morse
Background
Dolutegravir (DTG)-based antiretroviral therapy (ART) is now the preferred first-line regimen for people living with HIV (PLWH) globally, including in Zimbabwe, which has an estimated adult HIV prevalence of 12.9%. While DTG offers a high genetic barrier to resistance and favourable tolerability, it has been linked to metabolic abnormalities — including abdominal obesity, hypertension, dyslipidaemia, and impaired glucose regulation — that cluster together and increase the risk of cardiovascular disease and type 2 diabetes. Data on this burden remain limited in Zimbabwe. We conducted an exploratory, hypothesis-generating cross-sectional study to estimate the burden of hyperglycaemia and dyslipidaemia, and to identify their correlates, among PLWH on first-line DTG-based ART.
Objective
This study aimed to determine the burden and correlates of hyperglycaemia and dyslipidaemia in Zimbabwean adults living with HIV on first-line DTG-based ART.
Methods
A cross-sectional study was conducted from 20 January 2025–13 February 2025. The study participants were 171 PLWH receiving first-line DTG-based treatment at Parirenyatwa Group of Hospitals, in Harare, Zimbabwe. A structured questionnaire was administered to collect demographics, lifestyle information, clinical parameters and anthropometric indices. We calculated body mass index (BMI). Blood pressure measurements were taken with the participant in a resting position. Blood samples were collected and we measured HbA1c, glucose, total cholesterol (TC), HDL cholesterol (HDL-C), LDL cholesterol (LDL-C).
Results
Of the 171 participants, 67.8% were female, with a median age of 42.1 years (IQR 32.4–50.2). The majority had at least secondary education, and few were smokers (n = 9), while 23% reported alcohol use and 62.2% reported no regular exercise. Over half (57.9%) were overweight or obese, and 39.8% were hypertensive. The prevalence of dyslipidaemia and hyperglycaemia was 74.3% and 13.4%, respectively, with insulin resistance present in 56.1%. Non-ideal HDL-C was the most common lipid abnormality (50.5%), followed by raised LDL-C (33.3%), raised triglycerides (16%), and hypercholesterolaemia (10.3%). On multivariate analysis, increasing age was independently associated with hyperglycaemia (AOR 1.08, 95% CI 1.03–1.13, p = 0.002), while elevated blood pressure was independently associated with dyslipidaemia (AOR 2.64, 95% CI 1.03–6.78, p = 0.043).
Conclusion
Dyslipidaemia and hyperglycaemia are highly prevalent among Zimbabwean adults on DTG-based ART, with elevated blood pressure and increasing age as key independent correlates. As this population ages on long-term ART, routine, integrated screening of BMI, blood pressure, glucose, and lipid profile is essential to mitigate cardiometabolic risk and sustain the success of DTG-based ART in Zimbabwe.