Hepatic steatosis and lactic acidosis caused by stavudine in an HIV-infected patient.
Lactic acidosis and hepatic steatosis caused by mitochondrial toxicity of nucleoside reverse transcriptase inhibitors (NRTI) is a rare cause of liver disease with a high mortality rate. This report describes a male, HIV-positive patient with a 4-week history of nausea, vomiting and abdominal pain. His medication consisted of prednisone 5 mg od (because of auto-immune thrombocytopenia), didanosine (for 2 years) and stavudine (for 3 months). Laboratory studies showed cholestasis and elevation of aminotransferases. Lactic level was not measured. Liver biopsy revealed steatosis and cholestatic hepatitis. In the absence of other causes of liver disease a probable diagnosis of stavudine-induced hepatic toxicity was made. After discontinuation of NRTI, he recovered completely. Because lactic acidosis had not been confirmed, stavudine was restarted and within 1 week the lactate level increased significantly. Therefore stavudine was discontinued again. One year later the patient is doing well on a double protease inhibitor regimen. In conclusion, clinicians treating patients with NRTI should be aware of the risk of lactic acidosis and hepatic steatosis. When this is suspected, all NRTI must be stopped. The diagnosis can be made when elevated lactate levels and hepatic steatosis are present in the absence of other causes of liver disease.
Bleeker-Rovers
C P
CP
Rijnstate Hospital, Department of Internal Medicine, Arnhem, The Netherlands.
Kadir
S W
SW
van Leusen
R
R
Richter
C
C
D015746:Abdominal Pain / Q000139:chemically induced; D000140:Acidosis, Lactic / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D019380:Anti-HIV Agents / Q000009:adverse effects*; D001706:Biopsy; D056486:Chemical and Drug Induced Liver Injury; D005218:Fat Necrosis / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008107:Liver Diseases / Q000097:blood / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects*; D012307:Risk Factors; D018119:Stavudine / Q000009:adverse effects*; D014839:Vomiting / Q000139:chemically induced
D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors; D018119:Stavudine