Hyperlactatemia in human immunodeficiency virus-infected children receiving antiretroviral treatment

Pediatr Infect Dis J. 2003 Sep;22(9):778-82. doi: 10.1097/01.inf.0000083826.11124.b1.


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.

Publication types

  • Comparative Study

MeSH terms

  • Acidosis, Lactic / chemically induced*
  • Acidosis, Lactic / epidemiology
  • Adolescent
  • Age Distribution
  • Analysis of Variance
  • Anti-HIV Agents / adverse effects*
  • Anti-HIV Agents / therapeutic use
  • Child
  • Child, Preschool
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • HIV Infections / diagnosis
  • HIV Infections / drug therapy*
  • Humans
  • Incidence
  • Infant
  • Lactates
  • Lactic Acid / blood*
  • Male
  • Probability
  • Prospective Studies
  • Risk Assessment
  • Sex Distribution
  • Statistics, Nonparametric


  • Anti-HIV Agents
  • Lactates
  • Lactic Acid