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Associations of HIV and antiretroviral therapy with gestational diabetes in South Africa.
Bengtson, Angela M; Madlala, Hlengiwe; Matjila, Mushi J; Levitt, Naomi; Goedecke, Julia H; Cu-Uvin, Susan; McGarvey, Stephen T; Werner, Erika F; Myer, Landon.
Afiliación
  • Bengtson AM; Department of Epidemiology and International Health Institute, Brown University School of Public Health, Providence, Rhode Island, USA.
  • Madlala H; Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town.
  • Matjila MJ; Department of Obstetrics & Gynaecology, University of Cape Town and New Somerset Hospital.
  • Levitt N; Chronic Disease Initiative for Africa, Department of Medicine.
  • Goedecke JH; Health through Physical Activity, Lifestyle and Sport Research Centre, Division of Physiological Sciences, Department of Human Biology, University of Cape Town.
  • Cu-Uvin S; Biomedical Research and Innovation Platform, South African Medical Research Council, Cape Town, South Africa.
  • McGarvey ST; Department of Obstetrics and Gynecology and Medicine, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island.
  • Werner EF; Department of Epidemiology and International Health Institute, Brown University School of Public Health, Providence, Rhode Island, USA.
  • Myer L; Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, Massachusetts, USA.
AIDS ; 37(13): 2069-2079, 2023 11 01.
Article en En | MEDLINE | ID: mdl-37534696
OBJECTIVE: To estimate associations of HIV status and antiretroviral (ART) regimen with gestational diabetes (GDM) and postpartum glucose metabolism. DESIGN: Prospective cohort study. METHODS: We enrolled pregnant persons with HIV (PWH) and without HIV in Cape Town, South Africa who were at least 18 years of age at 24-28 weeks' gestation and followed up to 26 months postpartum. Participants were tested for GDM in pregnancy and for diabetes postpartum using a 75 g 2 h oral glucose tolerance test (OGTT) and diagnosed via WHO criteria. We estimated associations of HIV status and ART regime [efavirenz (EFV) versus dolutegravir (DTG)] with GDM and postpartum impaired glucose metabolism using multivariable log binomial or linear regression models. RESULTS: Among 397 participants [median age 30 (interquartile range (IQR) 25-34; n  = 198 without HIV, n  = 199 PWH], the prevalence of GDM was 6% (9 PWH versus 3% without HIV). In multivariable analyses, PWH were at higher risk of GDM [risk ratio (RR) 3.9, 95% confidence interval (CI) 1.4-10.7] after adjustment for prepregnancy BMI and other confounders. GDM risk did not differ by ART regimen (unadjusted prevalence 8.1% DTG versus 5.6% EFV, adjusted RR 1.1, 95% CI 0.2-6.6). Few participants had diabetes, impaired glucose tolerance (IGT), or impaired fasting glucose postpartum ( n  = 13, 6%) with no differences by HIV or ART status. CONCLUSION: In a setting of universal GDM testing, PWH had an increased risk of impaired glucose metabolism during pregnancy but not postpartum. Among PWH, GDM risk was similar regardless of EFV or DTG use. Given concerns about DTG and weight gain, diabetes risk should continue to be monitored.
Asunto(s)

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Infecciones por VIH / Diabetes Gestacional Tipo de estudio: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies País/Región como asunto: Africa Idioma: En Revista: AIDS Asunto de la revista: SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS) Año: 2023 Tipo del documento: Article

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Infecciones por VIH / Diabetes Gestacional Tipo de estudio: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies País/Región como asunto: Africa Idioma: En Revista: AIDS Asunto de la revista: SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS) Año: 2023 Tipo del documento: Article