6th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 25–28 October 2004 - Washington, DC, USA

PRE-ECLAMPSIA IN HIV-INFECTED PREGNANT WOMEN RECEIVING HIGHLY ACTIVE ANTIRETROVIRAL THERAPY IS ASSOCIATED WITH ENDOTHELIAL DYSFUNCTION AND INSULIN RESISTANCE

Antiviral Therapy 2004; 9(6):L15 (abstract no. 23)

M Larrousse, E Martínez, A Suy, M Lonca, E de Lazzari, A Milinkovic, L Zamora, A León, M Laguno, JL Blanco, J Mallolas, S Pisa, S Hernández, V Cararach, JA Vanrell, JM Gatell and O Coll
Hospital Clinic Barcelona, Barcelona, Spain

BACKGROUND: We have recently reported an unexpected high risk for pre-eclampsia in HIV-infected pregnant women receiving highly active antiretroviral therapy (HAART). Although this adverse effect was clinically associated with the duration of exposure to HAART prior to pregnancy, the underlying pathogenesis remains unknown.

METHODS: Stored plasma samples immediately prior to the estimated date of conception (time point 1), during pregnancy (time point 2), and in the puerperium (time point 3) for HIV-infected pregnant women who developed preeclampsia (cases) and at similar time points for randomly selected HIV-infected pregnant women who did not develop pre-eclampsia (controls) were used for measuring insulin (IRMA, Med-Genix Diagnostics, Fleunes, Belgium) and P- and E-selectin (R&D System, Minn., Minnesota). Insulin, and P- and E-selectin measurements were compared with the Kruskall–Wallis test.

RESULTS: There were nine cases and nine controls. P-selectin (ng/ml) showed a trend to increase over time both in cases and controls, but the increase in cases was significantly higher than in controls (time point 1: 26.9 ±13.2 vs 13.1 ±4.2, P=0.0087; time point 2: 45.5 ±26.3 vs 21.1 ±11.4, P=0.0211; time point 3: 60.6 ±24.3 vs 36.1 ±10.7, P=0.0136, respectively). Although there was a trend towards higher E-selectin (ng/ml) values in cases than in controls at the different time point studies, differences were not statistically significant (time point 1: 39.1 ±15.1 vs 27.3 ±13.5, P=0.0998; time point 2: 34.9 ±13.4 vs 33.5 ±15.6, P=0.8369; time point 3: 43.7 ±10.7 vs 31.8 ±13.1, P=0.0523, respectively). Because the volume of stored samples prior to pregnancy and in the puerperium was scarce, insulin could be measured only during pregnancy. Insulin (mU/l) during pregnancy was significantly higher in cases than in controls (time point 2: 36.0 ±33.2 vs 9.4 ±6.5, P=0.0311, respectively).

CONCLUSION: Endothelial dysfunction and insulin resistance may be potential underlying mechanisms involved in the pathogenesis of pre-eclampsia in HIV-infected pregnant women receiving HAART.

2004-10-25
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