title: Impaired glucose metabolism in HIV-infected pregnant women: a retrospective analysis.
abstract: Metabolic complications, including diabetes mellitus, have been increasingly recognised in HIV-infected individuals since the introduction of antiretroviral therapy, particularly protease inhibitors (PIs). Pregnancy is also a risk factor for impaired glucose metabolism, and previous studies have given conflicting results regarding the contribution of PIs to impaired glucose tolerance (IGT) and gestational diabetes mellitus (GDM) in pregnant HIV-infected women. We conducted a retrospective review of all HIV-infected women attending a combined infectious disease and antenatal clinic between 2007 and 2013 who underwent a 100 g oral glucose tolerance test (OGTT) at 24-28 weeks. We grouped the patients based on whether their OGTT result was normal or abnormal, and compared the groups using standard parametric tests (t-test and Fisher's exact test). Of 263 women with HIV who attended the clinic, 142 (53.9%) attended for OGTT and were eligible for inclusion. The mean age was 31 years (SD 5.37), all women were of European or African origin and 33.7% had a body mass index ≥30 kg/m(2) About 93.7% were on PI-based regimens. At delivery, the mean CD4 count was 526 cells/µL, and 13% of patients had a detectable viraemia. The prevalence of IGT was 2.8%, while the prevalence of GDM was 2.1%. Also, 71.4% (n = 5) of women with abnormal glucose metabolism were taking PIs versus 94.8% (n = 128) of normoglycaemic women (p = 0.06). We did not confirm an increased rate of GDM in HIV-infected women in our patient population and found no association between PI use and GDM.
authors.affiliation: Registrar in Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Moore
authors.affiliation: Registrar in Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: Hugh
authors.initials: H
authors.lastname: Adler
authors.affiliation: Clinical Scientist, Infectious Diseases (DOVE clinic), Rotunda Hospital, Dublin, Ireland.
authors.forename: Valerie
authors.initials: V
authors.lastname: Jackson
authors.affiliation: Specialist Midwife, Infectious Diseases (DOVE clinic), Rotunda Hospital, Dublin, Ireland.
authors.forename: Mairead
authors.initials: M
authors.lastname: Lawless
authors.affiliation: Consultant in Endocrinology, Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: Maria
authors.initials: M
authors.lastname: Byrne
authors.affiliation: Consultant in Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland.
authors.forename: Maeve
authors.initials: M
authors.lastname: Eogan
authors.affiliation: Consultant in Infectious Diseases, Medicine and Sexual Health, Rotunda Hospital and Mater Misericordiae University Hospital, Dublin, Ireland Senior Lecturer in Medicine, University College Dublin, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland jlambert@mater.ie.
authors.forename: John S
authors.initials: JS
authors.lastname: Lambert
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D016640:Diabetes, Gestational / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D018149:Glucose Intolerance / Q000453:epidemiology* / Q000209:etiology; D005951:Glucose Tolerance Test; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D017320:HIV Protease Inhibitors
keywords: AIDS; HIV; antiretroviral therapy; diabetes; impaired glucose tolerance; pregnancy; protease inhibitor; toxicity; women; treatment