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Hyperlactatemia in human immunodeficiency virus-infected children receiving antiretroviral treatment
Antoni Noguera1, Claudia Fortuny, Emilia Sanchez
1Infectious Diseases unit, Pediatric Department, Hospital Sant Joan de Déu-Hospital Clinic, University of Barcelona, 08950 Esplugues, Barcelona, Spain.
Insights
Hyperlactatemia, or elevated blood lactate, can occur in children with HIV on antiretroviral therapy. Younger age is a risk factor, and monitoring lactate is recommended for children under three years old.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Pharmacology
Background:
- Hyperlactatemia and lactic acidosis are known complications in adults with HIV on antiretroviral treatment.
- The incidence, course, and risk factors for hyperlactatemia in pediatric patients with HIV require further investigation.
Purpose of the Study:
- To determine the incidence, clinical course, and risk factors associated with hyperlactatemia in HIV-infected children receiving antiretroviral therapy.
Main Methods:
- A prospective observational study was conducted over 28 months involving 80 HIV-infected children on antiretrovirals.
- Venous lactate concentrations were measured every six months. Alanine levels were assessed when lactate was elevated to differentiate causes of hyperlactatemia.
Main Results:
- Twenty-three patients (29%) exhibited hyperlactatemia. Fourteen children (17%) had pathological alanine concentrations, with mean lactate peaks of 2.67 mmol/l, and remained asymptomatic without metabolic acidosis.
- Younger age at the initiation of antiretroviral treatment was identified as the only statistically significant risk factor for hyperlactatemia.
Conclusions:
- Symptom-free hyperlactatemia was observed in HIV-infected children treated with nucleoside analog reverse transcriptase inhibitors.
- Routine monitoring of blood lactate levels is advised for HIV-infected children under three years old receiving nucleoside analog reverse transcriptase inhibitors, regardless of symptoms.
Background:
Hyperlactatemia and lactic acidosis occur in HIV-infected adults receiving antiretroviral treatment. Our objective was to determine the incidence, course and risk factors for hyperlactatemia in our HIV-infected pediatric patients.
Design:
A prospective observational study of venous lactate concentrations during a 28-month period in 80 HIV-infected children, most of whom were receiving antiretrovirals.
Methods:
Venous blood lactate concentrations were measured every 6 months under optimal sample-obtaining conditions. Alanine values from the same blood sample were performed when lactate concentrations were elevated. Hyperalaninemia is observed only when mitochondrial oxidative phosphorylation is chronically disturbed.
Results:
Twenty-three patients (29%) were identified with hyperlactatemia, in 9 of the cases with normal alaninemia, probably caused by difficult venous punctures. The other 14 children (17%) had pathologic alanine concentrations with a mean lactate peak of 2.67 mmol/l (range, 2.05 to 4.9 mmol/l); none of them showed metabolic acidosis, and they were all symptom-free. Treatment was continued in all cases, and lactate has progressed spontaneously to normal values in 5 patients.
Conclusions:
Symptom-free hyperlactatemia was observed in HIV-infected children receiving nucleoside analog reverse transcriptase inhibitors. In our study, only a younger age at the beginning of antiretroviral treatment was a statistically significant risk factor for hyperlactatemia. Random measurements of blood lactate concentrations should be included in the clinical follow-up of those HIV-infected children <3 years of age who are treated with nucleoside analog reverse transcriptase inhibitors, symptomatic or not.
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