Hyperlactatemia and hepatic abnormalities in 10 human immunodeficiency virus-infected patients receiving nucleoside analogue combination regimens.
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.
University of California San Diego Medical Center, San Diego, CA, 92103, USA. tlonergan@ucsd.edu
J T
JT
Lonergan
C
C
Behling
H
H
Pfander
T I
TI
Hassanein
W C
WC
Mathews
D000140:Acidosis, Lactic / Q000139:chemically induced* / Q000150:complications; D000328:Adult; D000410:Alanine Transaminase / Q000032:analysis; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D056486:Chemical and Drug Induced Liver Injury; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000097:blood / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008107:Liver Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D009705:Nucleosides / Q000009:adverse effects* / Q000627:therapeutic use; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use
D019380:Anti-HIV Agents; D009705:Nucleosides; D018894:Reverse Transcriptase Inhibitors; D000410:Alanine Transaminase