Burden and determinants of hyperglycaemia and dyslipidaemia in Zimbabwean adults living with HIV on dolutegravir-based first-line antiretroviral therapy: A cross-sectional study

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.