Maternal Antiretroviral Therapy Reduces Neonatal Insulin Levels

The use of triple antiretroviral therapy during pregnancy is associated with significant decreases in neonatal insulin levels. Dr. Geraldo Duarte from University of Sao Paulo-Ribeirao Preto, Brazil stated that, "Better medications are needed to reduce the risk of vertical transmission of HIV-1," Although currently available antiretrovirals avoid this complication, "the rates of dangerous and unwanted effects are high."

Dr. Duarte and colleagues investigated the effect of antiretroviral drugs during pregnancy on the glucose and insulin levels in infants.
Insulin levels increased steadily during pregnancy, but maternal insulin levels were consistently lower among women treated with zidovudine (n=20) or with a triple-drug antiretroviral regimen (n=25) than among untreated women without HIV infection (n=12).

Glucose levels did not differ significantly between treated and untreated women or their infants, the report indicates.
Insulin levels, however, were significantly lower in neonates of women in the triple therapy group than in neonates of women in the untreated, uninfected control group, the researchers note.

There were no cases of maternal-to-infant transmission of HIV infection.

"These data may indicate that there is an early damaging effect of the antiretroviral drugs on fetal pancreatic function," the investigators write.

Dr. Duarte’s group plans to study the effects of all "antiretrovirals not only on the pancreatic function, but on the maternal and fetal lipid metabolism, too. All this research will be performed first in animals."
These findings do not imply that physicians should not treat pregnant HIV-infected women with antiretroviral drugs, Dr. Duarte stressed, but call attention to the need for better drugs.
Diabetes Care 2005;28:856-859.

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