Insulin resistance complicating pregnancy in a human immunodeficiency virus-infected patient treated with protease inhibitors and corticosteroids.
BACKGROUND
Protease inhibitor therapy in human immunodeficiency virus (HIV)-infected adults has been associated with onset or aggravation of glucose intolerance. We report a case of a pregnant HIV-infected woman receiving highly active antiretroviral therapy who developed acute onset of severe insulin resistance during treatment for preterm labor.


METHODS
A 26-year-old multigravida with HIV infection treated with highly active antiretroviral therapy presented in preterm labor. During treatment, including corticosteroids for fetal lung maturity, severe hyperglycemia and ketonemia suggestive of diabetic ketoacidosis were detected. Aggressive intravenous fluid and insulin therapy was necessary to correct hyperglycemia.


CONCLUSIONS
We found that HIV-positive pregnant women receiving highly active antiretroviral therapy may be at increased risk for development of glucose intolerance. The use of medications that impair glucose tolerance, for example, corticosteroids, may have a synergistic effect in aggravating insulin resistance. Additional screening for glucose intolerance later in the third trimester should be considered in these patients.
Aschkenazi
Sarit
S
Department of Obstetrics and Gynecology, North Shore University Hospital, Manhasset, New York 11030, USA.
Rochelson
Burton
B
Bernasko
James
J
Kaplan
Jonathan
J
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D001623:Betamethasone / Q000009:adverse effects* / Q000627:therapeutic use; D004357:Drug Synergism; D005260:Female; D005325:Fetal Organ Maturity / Q000187:drug effects; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D018149:Glucose Intolerance / Q000139:chemically induced*; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000009:adverse effects*; D006801:Humans; D007333:Insulin Resistance; D008168:Lung / Q000196:embryology; D007752:Obstetric Labor, Premature / Q000517:prevention & control; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*
D005938:Glucocorticoids; D017320:HIV Protease Inhibitors; D001623:Betamethasone