Lipids and lactate in human immunodeficiency virus-1 infected pregnancies with or without protease inhibitor-based therapy.

TitleLipids and lactate in human immunodeficiency virus-1 infected pregnancies with or without protease inhibitor-based therapy.
Publication TypeJournal Article
Year of Publication2007
AuthorsLivingston EG, Cohn SE, Yang Y, Watts HD, Bardeguez AD, Jones TB, Smith LM, Umbleja T, McComsey GA
JournalObstet Gynecol
Volume110
Issue2 Pt 1
Pagination391-7
Date Published2007 Aug
ISSN0029-7844
KeywordsAdolescent, Adult, Antiretroviral Therapy, Highly Active, Cholesterol, HDL, Cohort Studies, Female, HIV Infections, Humans, Infant, Low Birth Weight, Infant, Newborn, Lactic Acid, Pregnancy, Pregnancy Complications, Infectious, Pregnancy Outcome, Protease Inhibitors, Triglycerides
Abstract

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.

CONCLUSION: 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.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00017797

LEVEL OF EVIDENCE: II.

DOI10.1097/01.AOG.0000271210.79340.4c
Alternate JournalObstet Gynecol
PubMed ID17666616
Grant List1U01 AI 39156 / AI / NIAID NIH HHS / United States
2U01 AI 27658 / AI / NIAID NIH HHS / United States
3U01 AI 38558 / AI / NIAID NIH HHS / United States
5U01 AI 25883 / AI / NIAID NIH HHS / United States
N01 HD 33345 / HD / NICHD NIH HHS / United States
RR 000080 / RR / NCRR NIH HHS / United States
U01 AI 41089 / AI / NIAID NIH HHS / United States