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The Association of Gestational Diabetes with HIV Infection and Tuberculosis in Indian Women
Infection of HIV is associated with an increased diabetes risk, which also increases tuberculosis risk. It is unknown if similar associations exist with gestational diabetes (GDM). We screened pregnant women living with and without HIV for GDM using oral glucose tolerance testing. In a subgroup of women with latent tuberculosis (positive interferon-gamma [IFN-γ] release assay), we used supernatants from tuberculosis antigen tubes to compare cytokine levels from women with and without GDM, matched by age and HIV status. Of 234 women, 21 (9%) had GDM, 13.9% living with HIV, and 6.5% without HIV (P = 0.06). Compared with women without GDM, women with GDM had lower median IFN-γ (19.1 versus 141.9 pg/mL, P = 0.03) and interleukin-2 (18.7 versus 249 pg/mL, P < 0.01). Our study suggests that HIV infection is associated with an increased risk of GDM, which is associated with decreased Mycobacterium tuberculosis immune responses. Gestational diabetes screening should be prioritized in tuberculosis-endemic countries, especially in women living with HIV.
Author Notes
Financial support: Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health under award number R01HD081929 (A. G., J. S. M., M. A., N. G., and R. B.), by NIAID (National Institute of Allergy and Infectious Diseases) of the National Institutes of Health under award number UM1AI069465 (A. G. and N. G.) and K23AI129854 (J. S. M.), by the Fogarty International Center of the National Institutes of Health under award number D43TW009574 (S. N.) and D43TW009337 (P. C.), by the Weill Cornell Department of Medicine, Ujala Foundation, Kellen Foundation, Willowcroft Foundation, and Wyncote Foundation. We also acknowledge the support of Persistent in development of electronic data capture system. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or of the named company or Foundations.
Authors’ addresses: Puja Chebrolu and Daniel Fitzgerald, Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, NY, E-mails: puc9005@med.cornell.edu and dwf2001@med.cornell.edu. Mallika Alexander, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Trial Unit, Pune, Maharashtra, India, E-mail: mallika.alexander@yahoo.com. Ramesh Bhosale, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Trial Unit, Pune, Maharashtra, India, and Department of OB-GYN, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India, E-mail: drrameshbhosale@gmail.com. Shilpa Naik, Department of OB-GYN, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India, E-mail: shilunnaik@yahoo.co.in. Nikhil Gupte and Amita Gupta, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Trial Unit, Pune, Maharashtra, India, and Division of Infectious Diseases, Departments of Medicine and International Health, Johns Hopkins School of Medicine, Baltimore, MD, E-mails: nikhil_jhumit@yahoo.com and agupta25@jhmi.edu. Myung Hee Lee, Department of Biostatistics, Center for Global Health, Weill Cornell Medicine, New York, NY, E-mail: myl2003@med.cornell.edu. Pavan Kumar, National Institute for Research in Tuberculosis, Chennai, India, E-mail: pavankumarn@nirt.res.in. Subash Babu, National Institute for Research in Tuberculosis, Chennai, India, and National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, E-mail: sbabu@mail.nih.gov. Jyoti Mathad, Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, NY, and Department of OB-GYN, Weill Cornell Medicine, New York, NY, E-mail: jsm9009@med.cornell.edu.