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Obstetrics & Gynecology 2007;110:391-397
© 2007 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Lipids and Lactate in Human Immunodeficiency Virus-1–Infected Pregnancies With or Without Protease Inhibitor-Based Therapy

Elizabeth G. Livingston, MD1, Susan E. Cohn, MD2, Yang Yang, PhD3, Heather D. Watts, MD4, Arlene D. Bardeguez, MD5, Theodore B. Jones, MD6, Laura M. Smith, MPH7, Triin Umbleja, MSc3, Grace A. McComsey, MD8 for the Acquired Immunodeficiency Syndrome (AIDS) Clinical Trials Group A5084 Study Team*

From 1Duke University, Durham, North Carolina; 2University of Rochester, Rochester, New York; 3Harvard School of Public Health, Boston, Massachusetts; 4National Institutes of Health, Bethesda, Maryland; 5University of Medicine and Dentistry of New Jersey, Newark, New Jersey; 6Wayne State University, Detroit, Michigan; 7Frontier Science Technology and Research Foundation, Amherst, New York; and 8Case Western Reserve University, Cleveland, Ohio.

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






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