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Hyperlactatemia and in utero exposure to antiretrovirals: is the control group the clue?
Pere Soler-Palacín1, Andrea Martín-Nalda, Xavier Martínez-Gómez
1Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain. psoler@vhebron.net
Insights
Perinatal antiretroviral (ARV) exposure did not increase the risk of hyperlactatemia or neurological issues in infants born to HIV-infected mothers. This study found no significant difference in these conditions compared to infants exposed to hepatitis C virus (HCV).
Area of Science:
- Pediatric Infectious Diseases
- Neonatal Health
- Maternal-Fetal Medicine
Background:
- Perinatal antiretroviral (ARV) exposure has been linked to hyperlactatemia and lactic acidosis in infants of HIV-infected mothers.
- Understanding the incidence and impact of these conditions is crucial for infant health outcomes.
- Comparison with other perinatal exposures, like hepatitis C virus (HCV), provides valuable context.
Purpose of the Study:
- To determine the incidence of hyperlactatemia and lactic acidosis in HIV-exposed, uninfected infants during their first year of life.
- To compare these incidences with infants born to mothers with HCV infection.
- To investigate the relationship between hyperlactatemia and neurological/neurodevelopmental disorders in these infants.
Main Methods:
- A prospective, comparative cohort study included 79 infants (39 HIV-exposed, 40 HCV-exposed).
- Biochemical markers (lactate, alanine, liver enzymes, pH) were measured at multiple time points (1.5 to 12 months).
- Pathological hyperlactatemia defined as lactate >2.1 mmol/L and alanine >475 μmol/L; neurological and neurodevelopmental assessments were conducted.
Main Results:
- No significant differences in neurological disorders or neurodevelopmental delay were observed between HIV-exposed and HCV-exposed groups.
- Pathological hyperlactatemia occurred in 56.4% of HIV-exposed and 57.5% of HCV-exposed infants, with no significant difference (p=0.92).
- Hyperlactatemia was more frequent in preterm infants (p<0.05); ARV use was not associated with pathological hyperlactatemia or neurological disorders.
Conclusions:
- Perinatal ARV exposure was not associated with an increased incidence of pathological hyperlactatemia or neurological disorders in HIV-exposed infants.
- The incidence of hyperlactatemia was similar between infants exposed to ARVs and those exposed to HCV.
- Hyperlactatemia was not linked to adverse neurological or neurodevelopmental outcomes in the studied cohort.
Abstract:
Perinatal antiretroviral (ARV) exposure has been related to hyperlactatemia and lactic acidosis in infants born to HIV-infected mothers. Our objective was to determine the incidence of these conditions during the first year of life in uninfected infants born to HIV-infected mothers and compare the data with infants born to mothers with hepatitis C virus (HCV) infection. We investigated the relationships between hyperlactatemia and neurological and neurodevelopmental disorders by conducting a prospective, comparative cohort study (October 2004 to October 2007) consecutively including children of HIV- and HCV-infected mothers. Liver enzymes, pH, lactic acid, and plasma amino acids were determined at 1.5, 3, 6, and 12 months of life. Pathological hyperlactatemia was defined as lactate >2.1 mmol/liter together with alanine >475 μmol/liter. Seventy-nine patients (39 HIV-exposed patients and 40 unexposed patients) were included. Baseline maternal characteristics in the two groups were similar. Almost 90% of HIV-infected mothers received HAART during gestation, while 10.3% were given AZT monotherapy. Eight newborns received combined therapy and 31 received AZT-based monotherapy. Twelve patients (five exposed and seven nonexposed) had some neurological disorder, and four other patients (one vs. three) showed signs of neurodevelopmental delay, with no significant differences between the groups (p=0.34). Pathological hyperlactatemia was detected in 56.4% (95% CI 39.6-72.2) and 57.5% (95% CI 40.9-73.0) of patients, respectively (p=0.92), and this condition was more frequent in preterm children (p<0.05). ARV use during pregnancy and the neonatal period was not associated with pathological hyperlactatemia. The presence of hyperlactatemia was not associated with neurological or neurodevelopmental disorders. No association was established between the use of ARV agents and the development of hyperlactatemia or neurological disorders in HIV-exposed children during their first year of life.
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