Risk factors for lactic acidosis in HIV-infected patients treated with nucleoside reverse-transcriptase inhibitors: a case-control study.
A case-control study was undertaken to determine risk factors for lactic acidosis in human immunodeficiency virus-infected patients treated with nucleoside reverse-transcriptase inhibitors (NRTIs). From May 1996 to June 2000, 9 patients with lactic acidosis (defined as a plasma lactic acid level of >5 mM and plasma pH of <7.38) were identified. Control patients were randomly selected from among a large cohort of patients who initiated a dual NRTI regimen in 1996 or after. Two factors were associated with an increased risk of lactic acidosis: first, a creatinine clearance of <70 mL/min before lactic acidosis (OR, 15.8 [range, 3.0-86.5], P<10(-4)), and, second, a low nadir CD4+ T lymphocyte count before the inception of NRTI therapy (OR, 8.4 [range, 1.2-infinity], P=.03). The total cumulative exposure to NRTIs was not associated with an increased risk of lactic acidosis, nor was the cumulative exposure to any of the 4 NRTIs studied. According to these results, monitoring of creatinine clearance, especially in patients with a low nadir CD4+ T lymphocyte count, could lead to modifications in antiretroviral therapy in order to diminish the risk of occurrence of lactic acidosis.
Fédération de Médecine Interne, Maladies Infectieuses et Pathologies Tropicales, Hôpital Saint-André, Bordeaux, France. fabrice.bonnet@chu-bordeaux.fr
F
F
Bonnet
M
M
Bonarek
P
P
Morlat
P
P
Mercié
M
M
Dupon
M C
MC
Gemain
D
D
Malvy
N
N
Bernard
J L
JL
Pellegrin
J
J
Beylot
D000140:Acidosis, Lactic / Q000139:chemically induced* / Q000453:epidemiology; D000328:Adult; D016022:Case-Control Studies; D016049:Didanosine / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D012307:Risk Factors; D018119:Stavudine / Q000009:adverse effects / Q000627:therapeutic use
D018894:Reverse Transcriptase Inhibitors; D018119:Stavudine; D016049:Didanosine