Protease inhibitors were not associated with increased glucose tolerance or insulin resistance in a study of HIV-positive women who received protease inhibitor-based antiretroviral therapy during pregnancy.
The AIDS Clinical Trials Group 5084 Study Team, led by Dr. Jane E. Hitti of the University of Washington, Seattle, prospectively followed 149 HIV-1-infected women during pregnancy. Seventy-six women were taking protease inhibitors and 73 were not.
Fasting glucose, insulin and C-peptide levels were measured 1 hour after ingestion of 50 g glucose. Glucose intolerance, insulin resistance, pancreatic beta-cell function and pregnancy outcomes were assessed.
The investigators report, in an online release from the April issue of the American Journal of Obstetrics and Gynecology, that 57 of the 149 women (38%) had glucose intolerance. The incidence of gestational diabetes was 8% among women on protease inhibitors and 10% among those who were not.
These figures "are considerably higher than the expected norm of 20-25% and 2-5% in the general obstetric population," Dr. Hitti's team points out.
Risk factors for glucose intolerance were body mass index, Hispanic ethnicity and maternal age. However, the use of protease inhibitors was not associated with glucose intolerance, insulin resistance, abnormal beta-cell function or adverse pregnancy outcome.
The investigators speculate that "placentally mediated insulin resistance occurring in the context of normal pregnancy overwhelms any potential effect of protease inhibitors on insulin resistance in pregnancy."
"The possibly increased rate of gestational diabetes observed in this study population is of concern, although it may be related to population characteristics such as high body mass index and race/ethnicity," the researchers in the AIDS Clinical Trial Group point out.
"If corroborated in other cohorts of HIV-infected pregnant women, further study of the relationships among HIV, antiretroviral therapy, body mass index, and gestational diabetes would be warranted."
Am J Obstet Gynecol 2007;196:331.e1-331.e7.
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