Lactic acidosis in HIV-exposed infants with perinatal exposure to antiretroviral therapy.
BACKGROUND
Prolonged exposure to nucleoside reverse transcriptase inhibitors (NRTI) is known to be associated with lactic acidosis (LA) and hepatosteatosis. However, perinatal exposure to antiretroviral therapy (ART) and the subsequent development of symptomatic LA in infants, although recognised, is rarely reported in developing countries.


METHODS
Three infants born to HIV-infected mothers and who developed symptomatic lactic acidaemia associated with perinatal exposure to ZVD are reported. The first infant was HIV-infected and developed liver dysfunction and mental retardation at 5 months of age after exposure to 24 weeks of ZVD antenatally and 6 weeks of ZVD plus 4 weeks of ART triple-drug ART postnatally. The second and third infants were HIV-uninfected. The second infant had been exposed to ZVD for 14 weeks antenatally and for 6 weeks postnatally and presented with LA at 6 weeks of age. The third infant was exposed to ZVD, lamivudine and nevirapine for 9 weeks antenatally and 6 weeks of ZVD postnatally, and presented with life-threatening metabolic acidosis at 10 weeks.


CONCLUSIONS
In HIV-exposed infants, perinatal NRTI may lead to symptomatic LA and monitoring for symptoms is therefore essential.
Shah
Ira
I
HIV Clinic, Department of Pediatrics, B. J. Wadia Hospital for Children, Mumbai, India. irashah@pediatriconcall.com
D000140:Acidosis, Lactic / Q000139:chemically induced*; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D054303:HIV Reverse Transcriptase / Q000037:antagonists & inhibitors; D015497:HIV-1; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018743:Perinatal Care / Q000379:methods; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D015215:Zidovudine / Q000009:adverse effects* / Q000627:therapeutic use
D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors; D015215:Zidovudine; D054303:HIV Reverse Transcriptase