Hyperlactatemia and Hepatic Abnormalities in 10 Human Immunodeficiency Virus-Infected Patients Receiving Nucleoside Analogue Combination Regimens

Abstract

During a 6-and-a-half month period, we identified 10 human immunodeficiency virus (HIV)-infected men who were receiving antiretroviral regimens, including nucleoside analogues, and who developed unexplained reproducible hyperlactatemia in association with either abdominal symptoms or an unaccounted-for elevated alanine aminotransferase level, or both. After careful consideration of the possible etiologies, antiretrovirals were discontinued; lactate levels normalized in all patients. The estimated incidence of this phenomenon in our clinic was 20.9 cases per 1000 person-years of nucleoside analogue treatment. These observations extend the spectrum of the nucleoside analogue-induced lactic acidosis/hepatic steatosis syndrome by the identification of a subtle and perhaps earlier form, which has characteristic symptoms and laboratory abnormalities, and a favorable prognosis on discontinuation of antiretroviral therapy.

Factors Affecting Liver Fibrosis in Human Immunodeficiency Virus-And Hepatitis C Virus-Coinfected Patients: Impact of Protease Inhibitor Therapy

“…On the other hand, NRTIs have been recently shown to induce lactic acidosis and liver failure. 23 Although serum lactates were not measured routinely in our study population, we did not observe any surrogate markers of lactic acidosis (i.e., serum bicarbonate, or microvacuolar steatosis) in our population.…”

A Review of the Toxicity of HIV Medications

“…In all ten cases described by the authors, the patients were taking stavudine along with at least one other ARV medication. The cases had mean lactate concentrations of 4.4 mmol/L, and all had hepatic steatosis [61]. The severity of illness in this cohort was mild.…”

Hyperlactataemia and hepatic steatosis: mitochondrial toxicity of nucleoside reverse transcriptase inhibitors

“…9 In contrast, hyperlactataemia (which is usually asymptomatic) appears to be much more common-in one study it was estimated to be 20.9 cases per 1000 person years. 10 In a cross sectional study of 211 asymptomatic HIV infected patients, 39 (13.2%) had mild hyperlactataemia (lactate = 2.1 − 5.0 mmol/l). 11 Of these patients, 35 (89%) were receiving NRTI therapy.…”