Severe nucleoside-associated lactic acidosis in human immunodeficiency virus-infected patients: report of 12 cases and review of the literature.
Lactic acidosis is a rare but often fatal complication reported in some human immunodeficiency virus (HIV)-infected patients treated with nucleoside-analogue reverse-transcriptase inhibitors. We report a series of 12 patients with HIV infection treated with nucleoside analogues who developed unexplained metabolic acidosis. We have also reviewed 60 additional published cases. The aim of the present study is to describe the clinical picture, prognostic factors, and final outcome for nucleoside-associated lactic acidosis. The mortality rate is high: 33% for our patients, and 57% for the patients described in the literature. In the multivariate analysis, a lactate serum level of >10 mM (odds ratio [OR], 13.23; 95% confidence interval [CI], 2.96-59.25) was the only factor associated with higher mortality. The administration of specific therapy with cofactors against acidosis was associated with a lower mortality (OR, 0.17; 95% CI, 0.04-0.73). We conclude that specific therapy with cofactors may improve the outcome for patients with this syndrome.
Falcó
Vicente
V
Infectious Diseases Division, Hospital Vall d'Hebron, 08035 Barcelona, Spain. vfalco@hg.vhebron.es
Rodríguez
Dolors
D
Ribera
Esteban
E
Martínez
Esteban
E
Miró
José Maria
JM
Domingo
Pere
P
Diazaraque
Ruth
R
Arribas
José R
JR
González-García
Juan J
JJ
Montero
Francesc
F
Sánchez
Lluis
L
Pahissa
Albert
A
D000140:Acidosis, Lactic / Q000209:etiology* / Q000401:mortality; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008928:Mitochondria / Q000187:drug effects / Q000201:enzymology; D015999:Multivariate Analysis; D011379:Prognosis; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects*
D018894:Reverse Transcriptase Inhibitors