7th Annual Conference Of The British HIV Association [BHIVA] 27 – 29 April 2001, The Hove Centre, Brighton

[AUTHOR(S):] CJ Foster¹, H Boix², D Acolet², G Tudor-Williams¹, EGH Lyall¹
Imperial College School of Medicine at St Mary's, London, and ¹ The Chelsea and Westminster Hospital, London, UK

BHIVA Conf 2001 Apr 27-29;7:O20

INTRODUCTION: Nucleoside reverse transcriptase inhibitors (NRTIs) are administered perinatally to reduce the vertical transmission of HIV-1. Previous concerns regarding possible mitochondrial dysfunction in children exposed in utero to zidovudine (ZDV) alone or in combination with lamivudine (3TC) have been reported. We present three cases of unexplained neonatal lactic acidosis and/or hypoglycaemia in non- HIV-infected infants exposed perinatally to ZDV, 3TC and nevirapine.

CASE 1: 38/40-week infant delivered by caesarian section with poor CTG: APGAR 4/5/7; hepatosplenomegaly and anaemia; haemoglobin 4.4 g/dl, retics 1, DCT, TORCH screen and parvovirus-negative. Metabolic acidosis from birth to 72 hours, pH 7.06, pCO₂ 5.2, HCO₃ 10.1, BE 18.6 and lactate 2.8 mmol/l. Recurrent hypoglycaemia, glucose 1.6 mmol/l.

CASE 2: 36/40-week infant emergency caesarian section for maternal Pneumocystis carinii pneumonia (PCP) and premature labour. APGAR 8/9/10, initial gas pH 7.32. BE –4, glucose <1.0 mmol/l. Persistent severe hypoglycaemia for 96 hours.

CASE 3: 31/40-week infant emergency caesarian section for maternal pre-eclamptic toxaemia. APGAR 7/8/9. Lactic acidosis, pH 7.03, BE –22.6, lactate 6.5 and glucose 3.5 mmol/l. Macrocytosis MCV 140, coagulopathy, encephalopathy, liver and renal dysfunction.

RESULTS: All three infants responded to standard neonatal supportive care and are asymptomatic at 19, 26 and 4 months, respectively.

SUMMARY: Although we fully condone the use of antiretroviral therapy in pregnancy, these infants appeared to show acute mitochondrial toxicity, exacerbating neonatal stress. We suggest that all infants perinatally exposed to this therapy require early metabolic assessment.

PRESENTING AUTHOR: CJ Foster

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