Glucose production, oxidation and disposal correlate with plasma lactate levels in HIV-infected patients on HAART

Minimal effects of Darunavir on adipocyte differentiation and metabolism in 3T3-L1 cells

Darunavir (DRV) has been confirmed to be an effective option for antiretroviral-naïve and experienced patients. It results in a more favorable lipid and glucose profile than other antiretrovirals. The objective of this study was to investigate the molecular mechanisms that could underline the lack of toxicity of DRV to metabolism and the better profile observed in HIV-infected patients in comparison with other drugs. The effects of DRV on adipogenesis were evaluated by oil red O staining after 8 days of induction of differentiation in 3T3-L1 cells, a very adequate and convenient cell culture model for investigation of adipose function. Several adipogenic genes (C/EBPα, PPARγ, Pref-1, and AP2) were analyzed by real time-PCR. Fully differentiated adipocytes were also incubated with DRV for 24 h and glucose utilization and lactate and glycerol production were quantified by use of an autoanalyzer. No effects of DRV on murine adipocyte differentiation were observed. Significant decreases in lipolysis, glucose uptake, and lactate production were observed at the highest concentration used (50 μM:) (p < 0.01-p < 0.001). However, DRV treatment did not modify the percentage of glucose transformed into lactate. Co-treatment with RTV did not induce any further effects on lipolysis and glucose metabolism. This study suggests that the decrease in lipolysis observed after DRV treatment could explain, at least in part, the lower plasma lipids observed in patients under DRV/r treatment in comparison with other drugs. The lack of effects of RTV co-treatment on glucose and lipid metabolism emphasizes the safety of this treatment.

Point-of-care capillary blood lactate measurements in human immunodeficiency virus-uninfected children with in utero exposure to human immunodeficiency virus and antiretroviral medications

OBJECTIVES

To estimate the prevalence of elevated point-of-care (POC) capillary blood lactate concentrations in human immunodeficiency virus (HIV)-exposed, uninfected children (HEU) and to determine if POC lactate varies with in utero antiretroviral (ARV) exposure.

METHODS

The Surveillance Monitoring for Antiretroviral Therapy Toxicities protocol of the Pediatric HIV/AIDS Cohort Study enrolled 1934 children between 2007 and 2009, 0 to 12 years of age, born to HIV-infected mothers. POC lactate was measured annually on capillary blood using the Lactate Pro device. Associations of POC lactate with in utero ARV exposure and other characteristics were evaluated using logistic regression models, adjusting for maternal characteristics and other confounders.

RESULTS

Of 1641 children with POC measurements (median age, 3.0 years), 3.4% had POC lactate >3 mmol/L. Median POC lactate level decreased with age (1.9 mmol/L, 1.7 mmol/L, and 1.6 mmol/L for children 0-<6 months [99% ≤6 weeks of life], 6-<24 months, and ≥24 months of age, respectively; P < 0.001). Prevalence of elevated POC lactate did not differ by in utero ARV exposure drug class, but was significantly higher in children exposed in utero to emtricitabine or efavirenz, cocaine or opiates, and those of white race.

CONCLUSIONS

POC lactate testing is a useful rapid laboratory screening assay for HEU children with ARV exposure. ARV use during pregnancy has resulted in a dramatic decrease in mother-to-child transmission of HIV, and the risk of elevated lactate in HEU children is low. However, as new ARVs and more complex regimens are used during pregnancy by HIV-infected women, continued monitoring for infant toxicities is essential.