Concern has also been raised about mitochondrial dysfunction in HEU children due to in utero and postpartum exposure to ARVs, particularly Zidovudine (Poirier et al., 2003), which may affect neurodevelopment. Neuroimaging in ART-exposed children without symptoms may show abnormalities similar to those in children with congenital mitochondrial disease (Tardieu et al., 2005). Reassuringly, however, the Surveillance Monitoring for ART Toxicities (SMARTT) cohort of the Pediatric HIV/AIDS Cohort Study, including more than 3500 children, recently found no association between in utero exposure to ART drugs and cognitive or academic scores in school-age children (Van Dyke et al., 2016).