In young children receiving long-term antiretroviral therapy, including nucleoside analogues, for the prevention of perinatal HIV infection, mitochondrial toxicity has been described, manifested by increased lactate concentration (lactic acid) in the blood plasma, and it has therefore been proposed to consider this indicator as a screening replacement marker of mitochondrial dysfunction. At the same time, no reliable evidence of the above has yet been obtained.

In order to clarify this problem, Ekouevi D.K. et al. (France), a comparative and prospective study was conducted to assess the incidence of hyperlactatemia in children of women infected with HIV who received various antiretroviral treatment options. Observation of study participants began from the third trimester of pregnancy and continued until the child reached three months of age. Study participants received one of the following three antiretroviral regimens:

The determination of the lactate concentration in the blood plasma was carried out at 4, 6 and 12 weeks of life of the children using the "Cobas Integra 400" automatic biochemical analyzer.

In total, during the study, 836 blood plasma samples were taken from 338 children (262 from the study and 76 from the control group). The mean lactate concentration in the blood plasma was 1.8 mmol / L (interquartile range 1.2-2.7 mmol / L).

An increase in concentration above 2.5 mMol / L, considered to be hyperlactatemia, was observed in 39 of the 292 children in whom this indicator was determined 2 or more times. Furthermore, the incidence of hyperlactatemia in the study group did not differ significantly from that of the control group (11.6%, 95% confidence interval (CI) 6.3 to 19% in patients receiving first regimen vs 14.5%, 95% CI 8.5-22.5% in patients receiving a second regimen vs 14.3%, CI at 95% 7.1-24.7% in patients receiving the 3rd regimen; p = 0.79).

None of the hyperlactatemia cases were accompanied by clinical manifestations. In the vast majority of children, normalization of this indicator at 6 months of life has been noted, and only 3 persistent hyperlactemia have persisted.

On the basis of the data obtained, the authors conclude that hyperlactatemia, although it is relatively common in children born to mothers infected with HIV, has no significant link with the use of nucleoside analogues. According to the researchers, the concentration of lactate in the blood plasma is not a specific and sensitive marker of mitochondrial toxicity and cannot be used in current practice as a screening indicator.