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Updated: May 24, 2026

Rapid Screening of HIV Reverse Transcriptase and Integrase Inhibitors
Published on: April 9, 2014
Mitochondrial evolution in HIV-infected children receiving first- or second-generation nucleoside analogues
Constanza Morén1, Antoni Noguera-Julian, Glòria Garrabou
1Mitochondrial Research Laboratory, Internal Medicine Department, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain. cmoren1@clinic.ub.es
First-generation nucleoside reverse transcriptase inhibitors (1gNRTIs) used in highly active antiretroviral therapy (HAART) cause greater mitochondrial damage in children than second-generation NRTIs (2gNRTIs). This is evidenced by higher lactate levels and reduced cytochrome c oxidase activity, supporting the use of 2gNRTIs.
Area of Science:
- Pediatric infectious diseases
- Mitochondrial medicine
- Pharmacology
Background:
- Highly active antiretroviral therapy (HAART) can cause mitochondrial toxicity, a significant concern in HIV-infected children.
- Optimizing HIV treatment in children involves balancing cost-effectiveness with minimizing adverse effects, particularly mitochondrial toxicity.
Purpose of the Study:
- To evaluate the longitudinal changes in mitochondrial parameters in HIV-infected children on different antiretroviral regimens.
- To compare mitochondrial status between children on first-generation NRTIs (1gNRTIs) versus second-generation NRTIs (2gNRTIs).
Main Methods:
- A 2-year follow-up study of 28 HIV-infected children on HAART (15 on 1gNRTIs, 13 on 2gNRTIs), compared with 10 untreated HIV-infected patients and 27 uninfected controls.
- Assessed immunovirological status (CD4+ count, viral load) and mitochondrial parameters including lactate levels, mtDNA content, mitochondrial protein levels, oxidative stress, mitochondrial mass, and electron transport chain function in peripheral blood mononuclear cells.
Main Results:
- Children on 1gNRTIs showed significantly higher lactate levels compared to those on 2gNRTIs at the second time point (P=0.022).
- Mitochondrial DNA (mtDNA) content was similar across HIV-infected groups but lower than controls at baseline.
- A significant decline in cytochrome c oxidase activity over time was observed in HIV-infected patients, with a more pronounced decrease in the 1gNRTIs group.
Conclusions:
- HIV infection and 1gNRTIs contribute to greater mitochondrial damage over time compared to 2gNRTIs.
- Elevated lactate levels and reduced cytochrome c oxidase activity in the 1gNRTIs group suggest these drugs should be avoided in HIV-infected children when alternatives exist, aligning with international guidelines.
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