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AIDS Research and Treatment
Volume 2013 (2013), Article ID 249171, 7 pages
Clinical Study

Performance of Clinical Criteria for Screening of Possible Antiretroviral Related Mitochondrial Toxicity in HIV-Infected Children in Accra

1Department of Pediatrics, Yale School of Medicine, New Haven, CT 06520, USA
2Department of Child Health, Korle Bu Teaching Hospital, University of Ghana Medical School, P.O. Box kb77, Accra, Ghana
3Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT 06520, USA
4Department of Pharmacology, Yale School of Medicine, New Haven, CT 06520, USA

Received 12 December 2012; Revised 31 January 2013; Accepted 11 February 2013

Academic Editor: Guido Poli

Copyright © 2013 Allison Langs-Barlow et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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 ( ). Young age at HIV diagnosis or at HAART initiation was associated with (+) EPF ( ). Adherence to HAART trended toward an association with (+) EPF ( ). 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.