Adverse Events Among People Living with HIV Receiving Dolutegravir Based Regimens: Findings from a Six Month Active Pharmacovigilance Study in Uganda

BackgroundDolutegravir (DTG)-based antiretroviral therapy (ART) is recommended as firstline treatment for people living with HIV (PLHIV) in Uganda. However, data on its safety profile in routine care remain limited. This study actively monitored adverse events (AEs) among PLHIV receiving DTG based regimens, assessing factors associated with their occurrence. MethodsWe conducted a prospective cohort study nested within a parent cohort from July 2021 to September 2022 a cross three Ugandan sites (urban, peri urban, and rural). Adults on DTG/lamivudine/tenofovir (TLD), either transitioning from prior ART regimens or initiated on TLD as firstline therapy, were followed for six months. AEs were systematically captured using structured interviews and classified by the Medic al Dictionary for Regulatory Activities (MedDRA) System Organ Class. Univariable and multivariable logistic regression analyses identified predictors of AEs. ResultsAmong 607 participants, 50 (8.0%) reported adverse events (AEs). Neuropsychiatric disorders were most common (2.5%), followed by cardiovascular (1.8%) and reproductive system disorders (1.5%). Other AEs, including gastrointestinal, eye, and skin disorders, were rare (<1%). In multivariable analysis, participants at site {square}3 and being single had significantly lower odds of AEs (aOR {square}0.04, 95%{square}CI{square}0.00-0.29, p{square}={square}0.002), (a OR{square}0.45, 95%{square}CI{square}0.22-0.92, p{square}={square}0.028). Prior exposure to Zidovudine-based regimens was associate d with increased odds of AEs (aOR {square}3.33, 95%{square}CI{square}1.43-7.75, p{square}={square}0.005). ConclusionDTGbased ART regimens demonstrated a favourable safety profile, with AEs occurring infrequently and predominantly in neuropsychiatric, cardiovascular, and reproductive categories. Study site, Marital status and prior Zidovudine exposure were associated with AE risk, emphasizing the need for tailored monitoring, strengthened awareness in AE reporting and standardized pharm acovigilance across facilities.