The association between HIV, antiretroviral therapy and gestational diabetes mellitus: A systematic review and meta-analysis
OBJECTIVES: The widespread, chronic use of antiretroviral therapy (ART) raises questions concerning the metabolic consequences of HIV infection and treatment. Antiretroviral therapy, and specifically protease inhibitors (PIs), has been associated with hyperglycaemia. As pregnant women are vulnerable to development of hyperglycaemia, the objective of this study was to explore existing literature on the relationship between HIV infection, HIV treatment and gestational diabetes mellitus (GDM). METHODS: A systematic search was conducted in six databases for articles providing data on HIV-positivity, PI exposure, and GDM or glucose intolerance development in pregnancy. The quality of articles was evaluated using an adapted Cochrane Collaboration bias assessment tool. Risk ratios (RR) were generated from pooled data using meta-analysis the Mantel-Haenszel method. RESULTS: Of 891 references screened, six studies on the role of HIV-positivity, ten on PI use, and two on both were included. Meta-analysis showed no significant relationship between HIV infection and the development of GDM (RR 0.80, 95% CI=0.47-1.37, I2 = 0%). Meta-analysis of PI exposure showed increased GDM in studies using first-generation PIs (RR 2.29, 95% CI: 1.46-3.58) and studies using the strictest diagnosis criteria, the National Diabetes Data Group criteria for three-hour oral glucose tolerance test (RR 3.81, 95% CI 2.18-6.67). CONCLUSION: Meta-analysis showed no significant association between HIV-positivity and GDM. Significance of PI use was limited to studies using the strictest diagnostic criteria for GDM. Results are limited by high risk of bias. Well-designed prospective studies are needed to further clarify this relationship and its consequences for clinical practice.
Soepnel LM, Norris SA, Schrier VJ, Browne JL, Rijken MJ, Gray G, Klipstein-Grobusch K.
- General HIV+ population
- Engagement and Care Cascade