We report a HIV uninfected neonate born to HIV positive mother, who had tachypnea at birth. On investigations, he was found to have hyperlactatemia. All the secondary causes for elevated lactate were ruled out. Hyperlactatemia was attributed to the perinatal exposure, to maternal antiretroviral (ARV) drugs mainly nucleoside analogues. Asymptomatic and symptomatic hyperlactatemia is not uncommon in HIV exposed infants. Neonates with tachypnea, who are HIV and ARV exposed with no obvious cause, should be screened for arterial lactate.