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.
Bonnet
F
F
Fédération de Médecine Interne, Maladies Infectieuses et Pathologies Tropicales, Hôpital Saint-André, Bordeaux, France. fabrice.bonnet@chu-bordeaux.fr
Bonarek
M
M
Morlat
P
P
Mercié
P
P
Dupon
M
M
Gemain
M C
MC
Malvy
D
D
Bernard
N
N
Pellegrin
J L
JL
Beylot
J
J
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