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Pediatric Infectious Disease Journal:
Original Studies

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

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Abstract

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.

© 2003 Lippincott Williams & Wilkins, Inc.

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