Abstract
Mitochondrial damage is implicated in highly active antiretroviral therapy (HAART) toxicity. HIV infection also causes mitochondrial toxicity (MT). Differentiating between the two is critical for HIV management. Our objective was to test the utility of the Mitochondrial Disease Criteria (MDC) and the Enquête Périnatale Française (EPF) to screen for possible HAART related MT in HIV-infected children in Ghana. The EPF and MDC are compilations of clinical symptoms, or criteria, of MT: a (+) score indicates possible MT. We applied these criteria retrospectively to 403 charts of HIV-infected children. Of those studied, 331/403 received HAART. Comparing HAART exposed and HAART naïve children, the difference in EPF score, but not MDC, approached significance (P = 0.1). Young age at HIV diagnosis or at HAART initiation was associated with (+) EPF (P ≤ 0.01). Adherence to HAART trended toward an association with (+) EPF (P = 0.09). Exposure to nevirapine, abacavir, or didanosine increased risk of (+) EPF (OR = 3.55 (CI = 1.99–6.33), 4.76 (2.39–9.43), 4.93 (1.29–18.87)). Neither EPF nor MDC identified a significant difference between HAART exposed or naïve children regarding possible MT. However, as indicators of HAART exposure are associated with (+) EPF, it may be a candidate for prospective study of possible HAART related MT in resource-poor settings.
Highlights
Since the advent of highly active antiretroviral therapy (HAART), morbidity and mortality have been greatly reduced in children living with HIV [1]
The main objective of our study was to perform a retrospective chart review of those perinatally infected HIV positive children being treated for their disease at the Korle Bu Teaching Hospital in Accra, Ghana in order to assess whether the Enquete Perinatale Francaise (EPF) or Mitochondrial Disease Criteria (MDC) could be applied in this resource-poor setting as a potential screening tool for possible mitochondrial toxicity
The MDC did not demonstrate a difference between HAART experienced and HAART naive cohorts with regards to possible mitochondrial toxicity (P = 0.81)
Summary
Since the advent of highly active antiretroviral therapy (HAART), morbidity and mortality have been greatly reduced in children living with HIV [1]. There are other sequellae of mitochondrial dysfunction such as anemia, poor growth, and cognitive delay [18] that may have a greater impact on developing children than adults, and reports of mitochondrial toxicity in children are increasing [6, 19]. These side effects are a particular problem in those children who have acquired HIV perinatally, as they will likely remain on HAART throughout their lifetime. A need exists for a sensitive and low-cost screening tool to detect HAART associated mitochondrial toxicity in children living in resource-limited settings in order to help guide the allocation of further diagnostic resources where they are available or distribution of second-line HAART regimens
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