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Is Lactic Acid a Predictor of Mitochondrial Dysfunction in ARV-Exposed Noninfected Infants? C. GIAQUINTO*, A. DE ROMEO, V. GIACOMET, E. RUGA, A. B. BURLINA, A. DE ROSSI§, and R. D’ELIA.
Dept. of Pediatrics, Dept. of Oncology and Surgical Sci., AIDS Reference Ctr., Univ. of Padova, Italy Introduction: Recently eight children with mitochondrial dysfunction were described among children treated perinatally with NRTIs. Most of these children had a rise of lactic acid (LA), a marker of mitochondrial damage. We studied the level of lactic acid in the first months of life in a cohort of infants perinatally exposed to antiretroviral (ARV).
Methods: 11 infants born to HIV positive mothers from February 1999 were prospectically evaluated (group A). Together with routine clinical, virologic and laboratory evaluation LA level was measured monthly by enzymatic method on plasma. We considered as normal, values below 2.5 mmol/L(Documenta Geigy, 1996). To evaluate if there is a relationship between LA and ARV in older children we also studied a cohort of 36 HIV infected children (median age 9y; range: 5mo-17y) on combination therapy (group B).
Results: In group A 7/11 mothers were treated with ARVs in pregnancy (3 ZDVC/3TC, 1 ZDV, 3 HAART); 9 received IV ZDV during labor and all newborns were treated with ZDV monotherapy. The mean follow up of these children is 3.8 mo (range: 20d-7.5mo). 6/11 infants (54%) had LA level above normal (range: 1.1-5.3 mmol/L) always in the first months of life. However there is a negative trend of LA level over time and all children older than 3 months have normal value. One child is HIV-1 infected and all children are clinically and neurologically well. Only 3/36 in group B had slight increased (mean 2.8 mmol/L) of LA. There is no correlation between use of ZDV-containing regimens and abnormal level of LA.
Conclusions: LA level is abnormal in the first months of life in most children exposed to ARVs perinatally. Our findings showed that there is no correlation between high level and clinical signs and symptoms. However a longer follow up is needed.
Key Words: antiretrovirals, lactic acid, perinatal
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