[Antiretroviral agents and pregnancy: mitochondrial dysfunction and nucleoside analogs]

An alert was published during 1999 by the French Perinatal Cohort: eight cases of mitochondrial dysfunction were reported among 1754 infants exposed to nucleoside analogues in utero and during the neonatal period. These eight infants were not infected by HIV. Mitochondrial toxicity of nucleoside analogues is clearly described in adult HIV patients receiving NRTI. Zidovudine (the only and the first NRTI studied) induced mitochondrial DNA dysfunction in animals (monkeys) and neurobehavourial effects in mice at a dose similar to the human dose. Practitioners have been informed. Retrospective and prospective studies are in progress. The recommendations for prevention of maternofoetal transmission of HIV are not reassessed. Pregnant women in rich countries are receiving combination antiretroviral therapy. Information of women has to be undertaken and therapeutic strategies for maternal indication have to be discussed case by case. Careful long term follow up of children exposed to antiretroviral agents is a priority.