Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.
Departments of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, MA, USA.
HIV Med. 2021 Sep;22(8):715-722. doi: 10.1111/hiv.13120. Epub 2021 May 18.
There are few data on the prevalence of gestational diabetes (GDM) in pregnant women living with HIV (WLHIV) in sub-Saharan Africa, particularly those using integrase strand transfer inhibitors such as dolutegravir (DTG).
We prospectively enrolled pregnant WLHIV and pregnant women without HIV ≥18 years old in Gaborone, Botswana, excluding those with pre-existing diabetes. We screened for GDM using a 75 g oral glucose tolerance test (OGTT) performed at 24-28 weeks' gestation or at the earliest prenatal visit for those presenting after 28 weeks. Logistic regression models were fitted to assess the association between maternal HIV infection and GDM. Subgroup analyses were performed among WLHIV to assess the association between maternal antiretroviral therapy (ART) in pregnancy [DTG vs. efavirenz (EFV) with tenofovir/emtricitabine] and GDM.
Of 486 pregnant women, 66.5% were WLHIV, and they were older than women without HIV (median age 30 vs. 25 years, P < 0.01). Among WLHIV, 97.8% had an HIV-1 RNA level < 400 copies/mL at enrolment. Overall, 8.4% had GDM with similar rates between WLHIV and those without HIV (9.0% vs. 7.4%). The WLHIV receiving DTG-based ART had a 60% lower risk for GDM compared with those on EFV-based ART (adjusted odds ratio = 0.40, 95% CI: 0.18-0.92) after adjusting for confounders.
Pregnant WLHIV on ART in Botswana were not at increased risk of GDM compared with women without HIV. Among WLHIV, the risk of GDM was lower with DTG- than with EFV-based ART. Further studies with larger cohorts are warranted to confirm these findings.
在撒哈拉以南非洲，HIV 阳性孕妇（WLHIV）中妊娠糖尿病（GDM）的流行率数据较少，特别是那些使用整合酶链转移抑制剂（如多替拉韦）的孕妇。
我们前瞻性地招募了博茨瓦纳哈博罗内的 HIV 阳性孕妇和年龄≥18 岁的无 HIV 孕妇，排除了有既往糖尿病的孕妇。我们使用 75g 口服葡萄糖耐量试验（OGTT）在妊娠 24-28 周或妊娠后 28 周后最早的产前就诊时筛查 GDM。使用逻辑回归模型评估母体 HIV 感染与 GDM 之间的关联。在 WLHIV 中进行亚组分析，评估妊娠期间母体抗逆转录病毒治疗（ART）[多替拉韦与依非韦伦（EFV）联合替诺福韦/恩曲他滨]与 GDM 之间的关系。
在 486 名孕妇中，66.5%为 WLHIV，她们的年龄大于无 HIV 的孕妇（中位数年龄 30 岁 vs. 25 岁，P<0.01）。在 WLHIV 中，97.8%在入组时 HIV-1 RNA 水平<400 拷贝/ml。总的来说，8.4%的孕妇患有 GDM，WLHIV 和无 HIV 的孕妇 GDM 发生率相似（9.0% vs. 7.4%）。与接受 EFV 为基础 ART 的 WLHIV 相比，接受 DTG 为基础 ART 的 WLHIV 的 GDM 风险降低 60%（校正比值比=0.40，95%CI：0.18-0.92），校正混杂因素后。
在博茨瓦纳接受 ART 的 HIV 阳性孕妇与无 HIV 的孕妇相比，GDM 的风险并未增加。在 WLHIV 中，DTG 为基础 ART 的 GDM 风险低于 EFV 为基础 ART。需要进一步开展更大规模队列的研究来证实这些发现。
