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Hyperlactatemia in human immunodeficiency virus-infected children receiving antiretroviral treatment

NOGUERA, ANTONI MD; FORTUNY, CLAUDIA MD, PhD; SANCHEZ, EMILIA MD, PhD; ARTUCH, RAFAEL MD, PhD; VILASECA, MARIA ANTONIA PhD; MUÑOZ-ALMAGRO, CARMEN MD; POU, JORDI MD, PhD; JIMÉNEZ, RAFAEL MD, PhD

The Pediatric Infectious Disease Journal: September 2003 - Volume 22 - Issue 9 - p 778-782
doi: 10.1097/01.inf.0000083826.11124.b1
Original Studies

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.

From the Infectious Diseases Unit, Pediatric Department (AN, CF, JP, RJ), and the Laboratory Department (RA, AV, CMA), Integrated Unit Hospital Sant Joan de Déu-Hospital Clínic, Universitat de Barcelona; and Catalan Agency for Health Technology Assessment and Research, Catalan Health Service, Department of Health and Social Security, Generalitat de Catalunya (ES); Barcelona, Spain.

Accepted for publication May 2, 2003.

Address for reprints: Dr. Clàudia Fortuny, Servei de Pediatria, Hospital Sant Joan de Déu, Pass. Sant Joan de Déu n° 2, 08950 Esplugues (Barcelona), Spain. Fax 34 3 203 39 59; E-mail cfortuny@hsjdbcn.org.

© 2003 Lippincott Williams & Wilkins, Inc.