HIV and antiretroviral therapy (ART), including protease inhibitors, have been associated with gestational diabetes (GDM). Little data exist on GDM in pregnant women living with HIV (PWLHIV) in sub-Saharan Africa or on integrase strand transfer inhibitors such as Dolutegravir (DTG).
We prospectively enrolled PWLHIV and HIV-uninfected pregnant women >18 years from antenatal clinics in Gaborone, Botswana. Women with documented pre-existing diabetes were excluded. We screened for GDM using a 75-g Oral Glucose Tolerance Test (OGTT) performed at 24-28 weeks (wks) gestational age (GA) or at the earliest prenatal visit for those presenting after 28 wks. Fasting, 1-hour (hr), and 2-hr plasma glucose were measured. GDM was defined as meeting any of the following criteria: fasting glucose >92 mg/dL, 1-hr glucose >180 mg/dL, or 2-hr glucose >153 mg/dL. Data were compared between groups using Wilcoxon, Chi-square, or Fisher’s exact test as appropriate. Logistic regression models were fit to assess the association between maternal HIV infection and GDM. Subgroup analyses were performed amongst PWLHIV to assess the association between maternal ART use in pregnancy [DTG- vs. Efavirenz (EFV)-based] and GDM.
Of 178 women enrolled, 53% were PWLHIV. PWLHIV were older than HIV-uninfected women (median age 28 vs 24 yr, p<0.01) and more likely to have hypertension prior to pregnancy (5% vs 0%, p=0.05). Median gravida was higher in PWLHIV (3 vs 1, p<0.01). GA at OGTT and body mass index (BMI) did not differ between the two groups. Of PWLHIV, 95% had an HIV-1 RNA level <400 copies/mL and 95% were on ART (31% on EFV- and 69% on DTG-based ART) at the time of OGTT. All PWLHIV received a backbone ART of tenofovir/emcitritabine. Overall, 10.1% of women in the cohort had GDM. No significant difference between groups was seen (12% for PWLHIV vs 8% among HIV-uninfected women, p=0.62). This relationship persisted even after adjusting for confounders. In multivariable analysis, BMI was positively associated with GDM (Table). In addition, among PWLHIV, rates of GDM did not differ between women receiving DTG- vs. EFV-based ART (8% vs 18%, p=0.27).
PWLHIV in Botswana receiving EFV- or DTG-based ART were not at increased risk for GDM compared to uninfected women. These results are reassuring. Further studies in larger cohorts are warranted to confirm these findings with expanding global use of DTG in pregnancy.