733
Lipodistrophy before Pregnancy Is a Protease Inhibitor-independent Predictor of Hypertriglyceridemia during Pregnancy in HIV-infected Pregnant Women
M Floridia1, Giovanni Guaraldi*2, E Tamburrini3, M Ravizza4, C Tibaldi5, A Bucceri6, G Anzidei7, A Meloni8, A Vimercati9, E Dalle Nogare10, and for The Italian Group on Surveillance on Antiretroviral Treatment in Pregnancy.
1Inst Superiore di Sanità, Rome, Italy; 2Univ of Modena and Reggio Emilia, Modena, Italy; 3Catholic Univ, Rome, Italy; 4Univ of Milan and S Paolo Hosp, Italy; 5Univ of Turin and AO OIRM S Anna, Italy; 6Clin L Mangiagalli, Univ of Milan, Italy; 7Natl Inst of Infectious Diseases, L Spallanzani, Rome, Italy; 8Univ of Cagliari and S Giovanni di Dio Hosp, Italy; 9Univ of Bari and Policlin Hosp, Italy; and 10Hosp Casa del Sole, Palermo, Italy
Background:
Little is known about serum
lipid changes during pregnancy in HIV-infected women with a previous history of
lipodistrophy (LD).
Methods: Data were obtained from the Italian National
Program on Surveillance on Antiretroviral Treatment in Pregancy,
a prospective, national, multicenter cohort. Fasting
lipid values collected during routine clinical visits in pregnancy were
compared among treatment-experienced women according to the presence or absence
of LD before pregnancy and ongoing treatment with protease inhibitors (PI). The
occurrence of hyperlipidemia, defined according to
the NCEP ATP III thresholds, was assessed in univariate
and multivariate logistic regression analyses.
Results:
Information on LD was
available for 261 women. Compared with women without previous LD, women with LD
before pregnancy were older (35.3 vs 32.8 years, p <0.001), had longer ART experience
(340.3 vs 218.3 weeks; p <0.001), and showed significantly higher triglycerides values
at all trimesters (mean differences: 55.4, 102.2, and 72.3 mg/dL at first, second, and third trimester, respectively). A
similar but not significant trend was observed for total cholesterol. No
differences were observed for HDL- or LDL-cholesterol at any trimester.
Multivariate analysis showed an independent role of both treatment with PI and
history of LD on the development of hypertriglyceridemia
during pregnancy. After adjusting for ongoing use of PI and other potential co-factors,
LD remained an independent predictor of hypertriglyceridemia
at all trimesters, with a 3-fold increase in risk at the first trimester
(adjusted odds ratio [AOR]: 3.58, 95% confidence interval [95%CI] 0.95 to 13.5),
and an 8-fold increase at both the second (AOR 8.34, 95%CI 2.6 to 26.7) and
third trimester (AOR 8.89, 95%CI 2.27 to 29.0). Even among women not receiving
PI, women with LD before pregnancy had significantly higher levels of
triglycerides at all trimesters compared to women with no previous LD (mean
differences at first, second, and third trimester: 31.2, 83.2, and 87.2 mg/dL,
respectively; p = 0.036, 0.010,
0.015).
Conclusions: In HIV-infected pregnant women, a history of lipodystrophy is significantly associated with a higher
risk of hypertriglyceridemia during all pregnancy trimesters, independent of
protease inhibitor use, which is also a strong and independent predictive
factor. Both factors should be considered in the routine care of pregnant women
with HIV.
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