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

Abstract

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...

Management of Newborns from HIV-1 Seropositive Mothers: Results of a Single Center Implementation of the French National Guidelines

“…The overall prevalence of gestational diabetes Birth weight (g) 3,300 3,700 1,900 3,270 *: no absolute count available IVDU : intravenous drug user, AZT : azidothymidine, 3TC : lamivudine, NFV : nelfinavir Table 7: Four infected children's characteristics. mellitus that we observed (2.9%) was not significantly different in both groups and far lower than those reported by a Spanish team who found prevalence approximately 7% in a similar cohort [19]. There was no significant difference regarding frequency of neonatal complications identified in each group.…”

Mechanisms of Reduced Maternal and Fetal Lopinavir Exposure in a Rat Model of Gestational Diabetes

“…Reports of drug disposition being sensitive to disease have appeared in the literature for nearly 40 years (reviewed in Morgan et al, 2008); however, only in the last decade have the effects of disease during pregnancy, including gestational diabetes mellitus (GDM), been investigated (Wang et al, 2005;Petrovic et al, 2008;Anger and Piquette-Miller, 2010). Studies indicate that the prevalence of GDM in HIV-positive pregnant women far exceeds that of HIV-negative pregnant women (Watts et al, 2004;Kourtis et al, 2006;Martí et al, 2007;González-Tomé et al, 2008), but to the best of our knowledge, it is unknown if this has an effect on the disposition of highly active antiretroviral therapy drugs. In rats with streptozotocin (STZ)-induced GDM, we have observed recently that the plasma protein binding of the protease inhibitor saquinavir decreases because of displacement by elevated lipids, whereas the expression of hepatic Mdr1 and a variety of cytochrome P450 and UDP-glucuronosyltransferase enzymes increases (Anger and Piquette-Miller, 2010).…”

How Sweet It Is? Susceptibility to Diabetes Mellitus in HIV-1 Treatment

“…By contrast, another study reported gestational glucose intolerance was not associated with PI use [31]. Rates have been estimated at 8% [32,33], with maternal age [31,33], Hispanic ethnicity [31], and PI or s tavudine exposure [33] identified as risks.…”