3rd International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 23-26 October 2001, Athens, Greece

SYMPTOMATIC HYPERLACTATEMIA AND LACTIC ACIDOSIS IN HIV- INFECTED PATIENTS TAKING HIGHLY ACTIVE ANTIRETROVIRAL THERAPY

Antiviral Therapy 2001; 6(Suppl. 4):28 (abstract no. 36)

M Bickel, V Rickerts, K de Haas, T Lutz, S Staszewski and HR Brodt
Department of Infectious Disease, JW Goethe-University Clinic, Frankfurt, Germany

BACKGROUND: Symptomatic hyperlactatemia (SHL) and lactic acidosis (LA) are known complications of nucleoside reversetranscriptase inhibitor (NRTI) treatment.

OBJECTIVE: To further investigate cases of SHL and LA and to identify possible risk factors.

METHODS: Retrospective analysis of all cases diagnosed between 01/98 and 12/00 at the Frankfurt HIV Cohort. SHL was defined as a lactate level >2.4 mmol/l and the presence of symptoms such as fatigue, exercise intolerance, persistent nausea and/or vomiting or abdominal pain. LA was diagnosed if additionally the arterial pH value was below 7.25.

RESULTS: Twenty patients (12 females/8 males) have been identified. Seventeen patients had SHL and three had LA. Median age was 38 years (22-75) and median BMI was 19.5 (13.6-32.8) kg/m². Fourteen of 20 had a previous AIDS-defining event. Five of 20 had chronic hepatitis C, 3/20 chronic hepatitis Band 3/20 both. Two of 20 patients had chronic liver disease of unknown origin. By the time of diagnosis median lactate was 5.94 (3.74-25.3) mmol/l and median pH was 7.34 (6.88-7.33). Elevated alanine aminotransferase (ALT) levels was found in 13/20, apsartine aminotransferase (AST) levels in 13/20, LDH in 18/19 and CK in 10/12. All patients received HAART at the time of the event. HAART consisted of: two NRTIs plus one PI in 4/20, two NRTIs and one non-nucleoside reverse transcriptase inhibitor (NNRTI) in 1/20, three NRTIs in 7/20, three NRTIs and one PI in 2/20, three NRTIs and one NNRTI in 3/20 and four NRTIS in 3/20. NRTIs used for the treatment were: stavudine in 18/20, didanosine 15/20, lamivudine 13/20, abacavir 10/20, zidovudine 2/20. Cumulative duration of antiretroviral therapy was 46 (8-87) months. All patients discontinued highly active antiretroviral therapy after the diagnosis and lactate levels decreased thereafter. Four patients died due to multiorgan failure. In 11 of the remaining 16 patients lactate levels returned to normal 12 weeks after therapy cessation.

CONCLUSIONS: SHL and LA may be associated with stavudine, number of NRTIs, low BMI, female gender and chronic hepatitis. LDH and CK levels seem to parallel lactate levels. SHL and LA might also occur as an early complication of HIV treatment.

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