Matched case-control study to evaluate risk factors for hyperlactataemia in HIV patients on antiretroviral therapy.
BACKGROUND
Lactic acidosis is a life-threatening event during antiretroviral therapy (ART). Hyperlactataemia may be a prelude to acidosis. Our database study suggested that female gender, intercurrent illness and didanosine (ddI)-based regimens may increase risk of lactic acidosis. The aim of this matched case-control study was to identify risk factors for hyperlactataemia requiring screening.


METHODS
Cases were defined as patients with two consecutive lactate samples > or =3.5 mmol/L taken more than 1 week apart. Cases were matched to two controls on gender, use of ddI and total duration of therapy using a 6-month window on either side. Controls never had raised lactate >2.5 mmol/L. A conditional logistic regression analysis using the PHREG procedure in SAS (SAS Institute Inc, Cary, NC) was performed with a discreet logistic model stratified by matching variables.


RESULTS
Twenty-one cases were matched to 42 controls. In the univariate model, current use of stavudine (d4T), total cholesterol >5.3 mmol/L and glucose levels > or =5.2 mmol/L gave increased likelihood of persistent hyperlactataemia. The multivariate model showed current use of d4T to be a significant independent predictor of persistent hyperlactataemia.


CONCLUSIONS
The results of this case-control study indicate that, when controlling for ddI use, d4T use is an additional risk factor for hyperlactataemia.
Datta
D
D
Kobler Clinic, Chelsea and Westminster Hospital, London, UK. dattauk@yahoo.co.uk
Moyle
G
G
Mandalia
S
S
Gazzard
B
B
D000140:Acidosis, Lactic / Q000097:blood / Q000139:chemically induced*; D019380:Anti-HIV Agents / Q000009:adverse effects*; D016022:Case-Control Studies; D016049:Didanosine / Q000009:adverse effects*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D015999:Multivariate Analysis; D012307:Risk Factors; D012737:Sex Factors; D018119:Stavudine / Q000009:adverse effects*
D019380:Anti-HIV Agents; D019344:Lactic Acid; D018119:Stavudine; D016049:Didanosine