title: Symptomatic lactic acidosis in hospitalized antiretroviral-treated patients with human immunodeficiency virus infection: a report of 12 cases.
abstract: We retrospectively investigated the clinical and histopathologic features of hospitalized patients infected with human immunodeficiency virus who had symptomatic lactic acidosis syndrome at a university teaching hospital during 1995-2000. Twelve patients were identified, 11 during 1998-2000; of these, 5 died with rapid progression to otherwise unexplained multiple-organ failure. All had extensive prior exposure to nucleoside analog reverse-transcriptase inhibitors (NRTIs). At presentation, the most commonly identified NRTI component of antiretroviral regimens was stavudine plus didanosine. Eleven patients presented with abdominal pain, nausea, and/or emesis. Eight patients had prior acute weight loss (mean [+/-SD], 12+/-5.3 kg). Median venous plasma lactate levels were > or =2-fold greater than the upper limit of normal (2.1 mmol/L). Serum transaminase levels were near normal limits at presentation. Histopathologic studies confirmed hepatic macrovesicular and microvesicular steatosis in 6 patients. Concurrent chemical pancreatitis was identified in 6 patients. The increasing number of cases identified during the study period suggests that physicians better recognize symptomatic lactic acidosis and/or that cumulative NRTI exposure may increase the risk for this syndrome.
authors.affiliation: Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL 35294-0006 , USA.
authors.forename: M E
authors.initials: ME
authors.lastname: Coghlan
authors.forename: J P
authors.initials: JP
authors.lastname: Sommadossi
authors.forename: N C
authors.initials: NC
authors.lastname: Jhala
authors.forename: W J
authors.initials: WJ
authors.lastname: Many
authors.forename: M S
authors.initials: MS
authors.lastname: Saag
authors.forename: V A
authors.initials: VA
authors.lastname: Johnson
mesh_terms: D000140:Acidosis, Lactic / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D019380:Anti-HIV Agents / Q000009:adverse effects*; D015658:HIV Infections / Q000150:complications*; D006760:Hospitalization; D006801:Humans; D008099:Liver / Q000473:pathology; D011860:Radiography, Abdominal; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects*
chemical_list: D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors