Lipids and lactate in human immunodeficiency virus-1 infected pregnancies with or without protease inhibitor-based therapy.
OBJECTIVE
To evaluate the effect of protease inhibitors on lipid and lactate levels and gastrointestinal symptoms in pregnancy.


METHODS
Acquired Immunodeficiency Syndrome (AIDS) Clinical Trials Group (ACTG) A5084 was an observational cohort study of human immunodeficiency virus (HIV)-infected pregnant women. Women recruited between 20 and 34 weeks of gestation were required to be on a stable, highly active antiretroviral therapy (HAART) regimen, stratified by protease inhibitor compared with no protease inhibitor regimens. Interval history was assessed, and lipid and lactate levels were drawn every 8 weeks during pregnancy and 12 weeks postpartum, with levels closest to delivery and postpartum used for analysis. Statistical comparisons used Kruskal-Wallis and Fisher exact tests.


RESULTS
One-hundred fifty-eight women were evaluated. Total cholesterol levels (median 230 mg/dL, interquartile range [197, 259], compared with 212 [179, 246] mg/dL, P=.042) and triglycerides (median 224 mg/dL, interquartile range [187, 288], compared with 185 [142, 230] mg/dL, P<.001] were elevated in the protease inhibitor group during pregnancy and remained higher in this group after delivery (total cholesterol 185 [163, 224] mg/dl compared with 171 [140, 190] mg/dL, P<.004; triglycerides 122 [87, 175] mg/dL compared with 89 [66, 150] mg/dL, P=.02). No difference was seen in lactate levels or rates of gastrointestinal symptoms between groups. Obstetric outcomes were similar between the two groups. A higher number of low birth weight infants were born to women in the highest twentieth percentile of triglycerides compared with the lowest across medication groups.


CONCLUSIONS
Cholesterol and triglycerides were higher in protease inhibitor-treated women in pregnancy. Lactate and gastrointestinal symptoms were not different. A higher number of low birth weight infants were noted in women with high triglycerides, but other elevated lipid levels did not affect pregnancy outcomes.


BACKGROUND
ClinicalTrials.gov, www.clinicaltrials.gov, NCT00017797


METHODS
II.
Livingston
Elizabeth G
EG
Duke University, Durham, NC 27710, USA. livin001@mc.duke.edu
Cohn
Susan E
SE
Yang
Yang
Y
Watts
Heather D
HD
Bardeguez
Arlene D
AD
Jones
Theodore B
TB
Smith
Laura M
LM
Umbleja
Triin
T
McComsey
Grace A
GA
D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D008076:Cholesterol, HDL / Q000097:blood / Q000187:drug effects; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D019344:Lactic Acid / Q000097:blood; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood* / Q000188:drug therapy* / Q000821:virology; D011256:Pregnancy Outcome; D011480:Protease Inhibitors / Q000494:pharmacology*; D014280:Triglycerides / Q000097:blood
D008076:Cholesterol, HDL; D011480:Protease Inhibitors; D014280:Triglycerides; D019344:Lactic Acid