title: Lactic acidosis and hepatic steatosis associated with use of stavudine: report of four cases.
abstract: BACKGROUND
  An association between use of zidovudine and didanosine and a rare but life-threatening syndrome of hepatic steatosis, lactic acidosis, and myopathy has been reported.
  
  
  OBJECTIVE
  To describe the syndrome of hepatic steatosis, lactic acidosis, and myopathy in four patients taking stavudine.
  
  
  METHODS
  Case series.
  
  
  METHODS
  A community hospital in Washington, D.C., and National Institutes of Health Clinical Center, Bethesda, Maryland.
  
  
  METHODS
  Two men and two women with HIV-1 infection who were taking stavudine presented with lactic acidosis and elevated levels of aminotransferases. All patients required intensive care.
  
  
  METHODS
  Levels of lactic acid, alanine aminotransferase, aspartate aminotransferase, amylase, and lipase; computed tomography of the abdomen; liver biopsy (two patients); and muscle biopsy (two patients).
  
  
  RESULTS
  Histologic findings consistent with mitochondrial injury confirmed the diagnosis of hepatic or muscle abnormality.
  
  
  CONCLUSIONS
  Because hepatic steatosis may be life-threatening, physicians should consider it as a possible cause of elevated hepatic aminotransferase levels among patients taking stavudine.
authors.affiliation: Warren Grant Magnuson Clinical Center, National Institute of Allergy and Infectious Diseases Intramural AIDS Program. National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
authors.forename: K D
authors.initials: KD
authors.lastname: Miller
authors.forename: M
authors.initials: M
authors.lastname: Cameron
authors.forename: L V
authors.initials: LV
authors.lastname: Wood
authors.forename: M C
authors.initials: MC
authors.lastname: Dalakas
authors.forename: J A
authors.initials: JA
authors.lastname: Kovacs
mesh_terms: D000140:Acidosis, Lactic / Q000139:chemically induced*; D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D019380:Anti-HIV Agents / Q000009:adverse effects*; D001219:Aspartate Aminotransferases / Q000097:blood; D001706:Biopsy; D004359:Drug Therapy, Combination; D005234:Fatty Liver / Q000139:chemically induced*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D017240:Mitochondrial Myopathies / Q000139:chemically induced; D018482:Muscle, Skeletal / Q000201:enzymology; D018119:Stavudine / Q000009:adverse effects*; D013577:Syndrome; D014057:Tomography, X-Ray Computed
chemical_list: D019380:Anti-HIV Agents; D018119:Stavudine; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase