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Point-of-care Capillary Blood Lactate Measurements in Human Immunodeficiency Virusuninfected Children With In Utero Exposure to Human Immunodeficiency Virus and Antiretroviral Medications

Crain, Marilyn J. MPH, MD*,†; Williams, Paige L. PhD; Griner, Ray MPH; Tassiopoulos, Katherine DSc, MPH§; Read, Jennifer S. MD; Mofenson, Lynne M. MD; Rich, Kenneth C. MD;; for the Pediatric HIVAIDS Cohort Study

Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e318234c886
Pediatric HIV/AIDS
Abstract

Objectives: To estimate the prevalence of elevated point-of-care (POC) capillary blood lactate concentrations in human immunodeficiency virus (HIV)-exposed, uninfected children (HEU) and to determine if POC lactate varies with in utero antiretroviral (ARV) exposure.

Methods: The Surveillance Monitoring for Antiretroviral Therapy Toxicities protocol of the Pediatric HIV/AIDS Cohort Study enrolled 1934 children between 2007 and 2009, 0 to 12 years of age, born to HIV-infected mothers. POC lactate was measured annually on capillary blood using the Lactate Pro device. Associations of POC lactate with in utero ARV exposure and other characteristics were evaluated using logistic regression models, adjusting for maternal characteristics and other confounders.

Results: Of 1641 children with POC measurements (median age, 3.0 years), 3.4% had POC lactate >3 mmol/L. Median POC lactate level decreased with age (1.9 mmol/L, 1.7 mmol/L, and 1.6 mmol/L for children 0–<6 months [99% ≤6 weeks of life], 6–<24 months, and ≥24 months of age, respectively; P < 0.001). Prevalence of elevated POC lactate did not differ by in utero ARV exposure drug class, but was significantly higher in children exposed in utero to emtricitabine or efavirenz, cocaine or opiates, and those of white race.

Conclusions: POC lactate testing is a useful rapid laboratory screening assay for HEU children with ARV exposure. ARV use during pregnancy has resulted in a dramatic decrease in mother-to-child transmission of HIV, and the risk of elevated lactate in HEU children is low. However, as new ARVs and more complex regimens are used during pregnancy by HIV-infected women, continued monitoring for infant toxicities is essential.

Author Information

From the Departments of *Pediatrics and †Microbiology, University of Alabama School of Medicine, Birmingham, AL; ‡Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA; §Department of Epidemiology, Harvard School of Public Health, Boston, MA; ¶Pediatric, Adolescent, and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; and ‖Department of Pediatrics, University of Illinois at Chicago, Chicago, IL.

Accepted for publication August 25, 2011.

Presented in part at the Pediatric Academic Societies Annual Meeting, Abstract 4351.373; 2009; Baltimore, MD.

The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Institutes of Health or U.S. Department of Health and Human Services.

Conflicts of interest and sources of funding: The Pediatric HIV/AIDS Cohort Study (PHACS) is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development with cofunding from the National Institute of Allergy and Infectious Diseases, the National Institute on Drug Abuse, the National Institute of Mental Health, the National Institute of Deafness and Other Communication Disorders, the National Heart Lung and Blood Institute, the National Institute of Neurological Disorders and Stroke, and the National Institute on Alcohol Abuse and Alcoholism, through cooperative agreements with the Harvard University School of Public Health (U01 HD052102-04) (Principal Investigator: George Seage; Project Director: Julie Alperen) and the Tulane University School of Medicine (U01 HD052104-01) (Principal Investigator: Russell Van Dyke; Co-Principal Investigator: Kenneth Rich; Project Director: Patrick Davis). The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Marilyn J. Crain, MPH, MD, 1600 Seventh Ave S, 306A CHB, Birmingham, AL 35233. E-mail: mcrain@peds.uab.edu.

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© 2011 Lippincott Williams & Wilkins, Inc.