Background 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). Methods 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. Results 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. Conclusions 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.
Background Few data exist on early-life metabolic perturbations in newborns with perinatal HIV and antiretroviral (ARV) exposure (HEU) but uninfected compared to those without perinatal HIV exposure (HUU). Methods We enrolled pregnant persons living with HIV (PLHIV) [receiving tenofovir (TDF)/emtricitabine or lamivudine (XTC) plus dolutegravir (DTG) or efavirenz (EFV)] and pregnant individuals without HIV as well as their liveborn infants (NCT03088410). Newborns were randomized to receive either zidovudine (AZT) or nevirapine (NVP) postnatal prophylaxis. Pre-prandial Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) was assessed at birth and 1 month. Linear mixed models were fit to assess the association between in utero HIV/ARV exposure and average HOMA from birth to 1 month, adjusting for confounders. Results Of 450 newborns, 306 were HEU. HOMA-IR was higher in newborns HEU vs. HUU after adjusting for confounders (mean difference of 0.068 in log HOMA-IR, p = 0.037). Among newborns HEU, HOMA-IR was not significantly different between TDF/XTC/DTG vs. TDF/XTC/EFV in utero ARV exposure and between AZT vs. NVP newborn postnatal prophylaxis arms. Conclusions Newborns HEU vs. HUU had lower insulin sensitivity at birth and at 1 month of life, raising potential concern for obesity and other metabolic perturbations later in life for newborns HEU.
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