Published online September 1, 2006
PEDIATRICS Vol. 118 No. 4 October 2006, pp. e1071-e1077 (doi:10.1542/peds.2006-0371)
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ARTICLE

Serum Lactate Levels in Infants Exposed Peripartum to Antiretroviral Agents to Prevent Mother-to-Child Transmission of HIV: Agence Nationale de Recherches Sur le SIDA et les Hépatites Virales 1209 Study, Abidjan, Ivory Coast

Didier Koumavi Ekouevi, MD, PhDa,b, Ramata Touré, PharmDc, Renaud Becquet, PhDa, Ida Viho, MDb, Charlotte Sakarovitch, MScb, François Rouet, PharmDc, Besigin Towne-Gold, MD, MScb, Patricia Fassinou, MDd, Valériane Leroy, MD, PhDa, Stéphane Blanche, MD, PhDe, François Dabis, MD, PhDa for the Agence Nationale de Recherches Sur le SIDA 1201/1202 Ditrame Plus Study Group

a Unité Institut National de la Santé et de la Recherche Médicale 593, Institut de Santé Publique, Epidémiologie et Développement, Université Victor Segalen, Bordeaux, France
b Projet Agence Nationale de Recherches sur le SIDA Ditrame Plus, Programme PACCI, Centre Hospitalier Universitaire de Treichville, Abidjan, Ivory Coast
c Centre de Diagnostic et de Recherches sur le SIDA, Centre Hospitalier Universitaire de Treichville, Abidjan, Ivory Coast
d Service de Pédiatrie, Centre Hospitalier Universitaire de Yopougon, Abidjan, Ivory Coast
e Service de Pédiatrie, Centre Hospitalier Universitaire Necker Enfants Malades, Paris, France

BACKGROUND. Mitochondrial toxicity was described in infants exposed to long-term antiretroviral regimens containing nucleoside analogues for the prevention of mother-to-child transmission of HIV. We measured the serum lactate levels in children born to HIV-1 infected African women receiving short-term antiretroviral prevention of mother-to-child transmission of HIV regimens.

METHODS. A prospective study was conducted in women-child pairs from the third trimester of pregnancy to 3 months of life. The exposed group was formed by children exposed in utero to nucleoside analog antiretroviral regimens, zidovudine or zidovudine + lamivudine from 32 to 36 weeks of amenorrhea until delivery. All of these women received nevirapine single dose at the beginning of labor. The children received zidovudine during the first 7 days of life and a nevirapine single dose at day 3. The control group was formed by infants born to HIV-1-infected women who had received nevirapine single dose only and who were not exposed to nucleoside analog antiretroviral regimens. Serum lactate levels were measured at 4, 6, and 12 weeks of life by Cobas Integra 400.

RESULTS. A total of 836 blood samples from 338 infants was collected (262 exposed and 76 controls). Median lactacidemia was 1.8 mmol/L (interquartile range: 1.2–2.7 mmol/L). Overall serum lactate levels ≥2.5 mmol/L, defining hyperlactatemia, were observed in 39 of the 292 infants who had ≥2 serum lactate measurements. The 3-month period prevalence of hyperlactatemia did not differ between the exposed group and the control group. All of the serum lactate levels returned to normal values in all of the subsequent samples. No case of symptomatic hyperlactatemia was detected during the study period.

CONCLUSIONS. Increased lactate levels were identified equally in infants whose mother received short-term nucleoside analogs or nevirapine single dose for prevention of mother-to-child transmission of HIV. Although not rare, hyperlactatemia was not related to short-term exposure to nucleoside analog antiretroviral regimens.

Key Words: hyperlactatemia • HIV infection • children • mitochondrial injury • vertical transmission • Africa

Abbreviations: ARV—antiretroviral therapy • PMTCT—prevention of mother-to-child transmission of HIV • NVPsd—nevirapine single dose • ANRS—Agence Nationale de Recherches sur le SIDA et les Hépatites Virales • CI—confidence interval • NRTI—nucleoside analog reverse transcriptase inhibitor

Accepted Apr 19, 2006.


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