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Session 26 Oral Abstract Session Pediatric/Maternal-Fetal HIV Infection and Issues in HIV-Infected Women Session Time: Wednesday, 10 am - 12:30 pm Room 606-609

10:30   113. Lactic Acidemia in Infants Exposed to Perinatal Antiretroviral Therapy A. Alimenti*, G. Ogilvie, D. Burdge, D. Money,, and J. Forbes Univ. of British Columbia, Children's and Women's Hlth. Ctr. of British Columbia, Vancouver, Canada Background: A prospective, observational study was conducted to investigate the potential mitochondrial toxicity of antiretroviral exposure during the perinatal period in HIV-uninfected infants by determining lactate levels. Previous studies show normal lactate beyond the first week of life in infants not exposed to HAART. Methods: Plasma lactate was measured repeatedly during the first 6 months of life in a consecutive cohort of 25 infants exposed to HAART in utero and zidovudine during the neonatal period. Peak lactate was analysed for type and length of HAART during pregnancy, and co-exposure to maternal substance use (Pearson chi2, odds ratios, t-tests). Results: Lactate was above normal limit at 2.1 mmol/L (>1 measurement) in 23/25 (92%) infants and reached levels >5 mmol/L in 9/25 (36%). The hyperlactatemia was persistent, resolving by the age of 6 months in most infants. 1 infant had symptoms consistent with those of adult lactic acidemia. HAART consisted of 2 NRTIs (ZDV/3TC most often) and nevirapine (20/25) or a PI (5/25). The mean duration of HAART exposure in utero was 17 weeks (range 3.5-38). Half of the infants were co-exposed to heroin, cocaine, or methadone. Maternal lactate level was normal in 17 mothers tested at the end of pregnancy. No association was found between the infant peak lactate and the duration of HAART during pregnancy (mean 4.2 vs 4.1 for <20 vs >20 weeks, p=0.9), exposure to stavudine (p=0.6), nevirapine vs PI-containing regimens (p=0.2) or co-exposure to substance use (p=0.3). Conclusions: This is one of the first prospective observational studies describing lactic acidemia in HIV uninfected infants exposed to HAART during the perinatal period. The hyperlactatemia was noted in 92% of the infants, and was above 5 mmol/L in one third. We hypothesize that the persistent hyperlactatemia is a consequence of mitochondrial toxicity from the transplacental and neonatal exposure to antiretroviral agents, as well as of impaired hepatic lactate clearance. Further study is required to determine the factors impacting on the hyperlactatemia and its clinical significance. Clinical follow-up and monitoring of lactate levels is recommended during the first 6 months of life in all infants exposed to perinatal HAART.

©2002 9th Conference on Retroviruses and Opportunistic Infections