Effect of antiretroviral agents on carbohydrate metabolism in HIV‐1 infected pregnant women

Beitune, Patrícia El; Duarte, Geraldo; Foss, Milton César; Montenegro, Renan Magalhães; Spara, Patrícia; Quintana, Silvana Maria; Figueiró-Filho, Ernesto Antônio; Costa, Antônio Gadelha da; Filho, Francisco Mauad

doi:10.1002/dmrr.576

Cited by 19 publications

(8 citation statements)

References 17 publications

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“…Eight per cent of the whole group developed GDM (25% in the HAART/PI group) [25]. Another prospective study analysed the area under the glycaemia curve (AUC) over a period of 120 min between the 33rd and 38th week of gestation on 57 pregnant women [26]. While an increase in the AUC along pregnancy was observed, this increase was significant only in the population receiving HAART therapy, indicating that PI was the likely cause of the glucose intolerance [26].…”

Section: Discussionmentioning

confidence: 99%

Gestational diabetes mellitus in a cohort of HIV‐1 infected women

et al. 2008

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ObjectivesWe undertook a prospective study to estimate the prevalence of gestational diabetes mellitus (GDM) and associated risk factors in a cohort of 669 HIV-1 infected women. MethodsThe O'Sullivan and glucose tolerance tests were performed during regular visits of 609 mothers. ResultsThe median age of the cohort was 30.7 years (range 16-44), with most women having had heterosexual contact (67%). The majority were in Centers for Disease Control (CDC) category A (71%) and 53% exhibited hepatitis C co-infection. Median viral load and CD4 count at third trimester were 545 cells/mL (range 139-1690 cells/mL) and 1.9 log (range 1.7-5.4), respectively. Seventy-four per cent of the patients were treated with highly active antiretroviral therapy (HAART), of whom 41% received a protease inhibitor (PI). An above-average prevalence of 7% [95% confidence interval (CI) 5.2-9.5] for positive GDM diagnosis was found. Risk factors associated with GDM in univariate analysis included older age, hepatitis C co-infection, stavudine and PI exposure. However, only older age [adjusted odds ratio (AOR) 1.09, 95% CI 1-1.1] and PI exposure (AOR 2.4, 95% CI 1-5.3) remained as independent risk factors for GDM development in multivariate analysis. ConclusionsIn our cohort, the prevalence of GDM appears to be increased, with older age and PI exposure contributing as significant independent risk factors.Keywords: antiretroviral therapy, gestational diabetes mellitus, HIV infection, pregnancy, protease inhibitor IntroductionThe effect of highly active antiretroviral therapy (HAART) on glucose metabolism in pregnant HIV-infected women remains poorly understood. This is partly because data on the use of antiretrovirals (ARVs) in gestational diabetes mellitus (GDM) patients are limited and because previous studies have shown contradictory results. The incidence of GDM in HIV-negative Spanish pregnant women ranges from 2% to 5% [1][2][3]. Some studies have reported an increased prevalence of diabetes ranging from 2% to 7% among HIV-infected patients receiving protease inhibitors (PIs) [4][5][6][7][8][9][10][11][12][13][14]. Although PI treatment has previously been associated with diabetes mellitus (DM), other factors such as age or body mass index (BMI) may also contribute to its development [15]. Classical risk factors for the development of DM in the general population include genetic make-up and individual factors such as race, age, family history of DM and obesity, which can also contribute to changes in plasma glucose levels in HIV-infected patients.The aim of this study is to assess the prevalence of GDM in a large cohort of HIV-1 infected women and to determine possible risk factors associated with its development in these women.Correspondence: Dr Maria Isabel Gonzalez-Tomé, Department of Immunodeficiencies, Hospital 12 de Octubre, Madrid 28041, Spain. Tel: 1 34 9 1390 8569; fax: +34 9 1390 8375; e-mail: maribelgt@hotmail.com DOI: 10.1111/j.1468-1293.2008.00639.x HIV Medicine (2008 Every 3 months, additional testing was carried out. Son...

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Section: Discussionmentioning

confidence: 99%

Gestational diabetes mellitus in a cohort of HIV‐1 infected women

et al. 2008

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“…Analysis of the PACTG 316 study revealed an increased risk of gestational diabetes mellitus in women receiving PI-based HAART before or early in pregnancy 67. Prospective studies have reported similar results 68,69. However, other authors have found no association between PI use and glucose intolerance in either retrospective studies45,70 or larger prospective trials 71…”

Section: Gestational Diabetes Mellitusmentioning

confidence: 97%

Safety of protease inhibitors in HIV-infected pregnant women

Chougrani

Luton²,

Matheron³

et al. 2013

HIV

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The dire conditions of the human immunodeficiency virus/acquired immune deficiency syndrome epidemic and the immense benefits of antiretroviral prophylaxis in prevention of mother-to-child transmission far outweigh the potential for adverse effects and undeniably justify the rapid and widespread use of this therapy, despite incomplete safety data. Highly active antiretroviral therapy has now become standard care, and more than half the validated regimens include protease inhibitors. This paper reviews current knowledge of the safety of these drugs during pregnancy, in terms of maternal and fetal outcomes. Transfer of protease inhibitors across the placenta is known to be minimal, and current data about birth defects and fetal malignancies are reassuring. Maternal liver function and glucose metabolism should be monitored in women treated with protease inhibitor-based regimens, but concerns about the development of maternal resistance, should treatment be discontinued, have been shown to be groundless. Neonates should be screened for hematologic abnormalities, although these are rarely severe or permanent and are not usually related to the protease inhibitor component of the antiretroviral combination. Current findings concerning pre-eclampsia and growth restriction are discordant, and further research is needed to address the question of placental vascular complications. The increased risk of preterm birth attributed to protease inhibitors should be interpreted with caution considering the discrepant results and the multitude of confounding factors often overlooked. Although data are thus far reassuring, further research is needed to shed light on unresolved controversies about the safety of protease inhibitors during pregnancy.

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“…The inconsistencies of the available results do not permit an analysis of whether HIV increases or decreases the rate of preeclampsia and how ARV therapy affects this rate [97]. Some prospective studies have reported an increased risk of gestational diabetes mellitus in women receiving PI-based HAART before or early in pregnancy [98][99][100], but other authors have found no association between PI use and glucose intolerance [101,102,51]. Further investigations are needed to assess the association between ART and gestational diabetes mellitus, and a close monitoring of glucose level is recommended.…”

Section: Protease Inhibitormentioning

confidence: 99%