title: Absence of sustained hyperlactatemia in HIV-infected patients with risk factors for mitochondrial toxicity.
abstract: BACKGROUND
  The prevalence of asymptomatic hyperlactatemia among HIV-infected individuals has been reported to be 4% to 36%. This variability may reflect differences in the definition of and risk factors for hyperlactatemia and/or techniques for venous lactate collection.
  
  
  METHODS
  We examined the prevalence of elevated venous lactate collected in accordance with Adult AIDS Clinical Trials Group (AACTG) guidelines among HIV-infected and nucleoside analogue-treated subjects with risk factors associated with hyperlactatemia. Sustained hyperlactatemia was defined as 2 consecutive levels >or=1.5 but <or=4 times the upper limit of normal (ULN) within 30 days.
  
  
  RESULTS
  Eighty-three subjects were enrolled. Two thirds had >or=2 risk factors, with 11% having >4 risk factors. The median entry venous lactate level was 1.2 mmol/L (range: 0.7-5.1 mmol/L). Two subjects had a lactate level >1.5 times the ULN: 1 with a value of 2.1 times the ULN at entry and a week 2 level of 1.2 times the ULN and a second subject with a week 2 value of 1.9 times the ULN but an entry level of 1.4 times the ULN. The latter subject developed symptomatic lactic acidosis 3 weeks following study discontinuation.
  
  
  CONCLUSIONS
  Sustained asymptomatic hyperlactatemia among subjects with risk factors associated with hyperlactatemia was not observed when venous lactate was measured in a standardized fashion. One case of hyperlactatemia that evolved into symptomatic lactic acidosis was diagnosed soon after the completion of the study, however. Our findings indicate that asymptomatic hyperlactatemia is either very rare or an artifact of collection technique.
authors.affiliation: Department of Medicine, University of North Carolina, Chapel Hill, USA. wohl@med.unc.edu
authors.forename: David A
authors.initials: DA
authors.lastname: Wohl
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Pilcher
authors.forename: Scott
authors.initials: S
authors.lastname: Evans
authors.forename: Manuel
authors.initials: M
authors.lastname: Revuelta
authors.forename: Grace
authors.initials: G
authors.lastname: McComsey
authors.forename: Yijun
authors.initials: Y
authors.lastname: Yang
authors.forename: Robert
authors.initials: R
authors.lastname: Zackin
authors.forename: Beverly
authors.initials: B
authors.lastname: Alston
authors.forename: Stacey
authors.initials: S
authors.lastname: Welch
authors.forename: Michael
authors.initials: M
authors.lastname: Basar
authors.forename: Angela
authors.initials: A
authors.lastname: Kashuba
authors.forename: Pualani
authors.initials: P
authors.lastname: Kondo
authors.forename: Ana
authors.initials: A
authors.lastname: Martinez
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Giardini
authors.forename: Joseph
authors.initials: J
authors.lastname: Quinn
authors.forename: Melvin
authors.initials: M
authors.lastname: Littles
authors.forename: Harry
authors.initials: H
authors.lastname: Wingfield
authors.forename: Susan L
authors.initials: SL
authors.lastname: Koletar
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D005006:Ethnicity; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D006801:Humans; D007773:Lactates / Q000097:blood*; D008297:Male; D008659:Metabolic Diseases / Q000453:epidemiology / Q000473:pathology* / Q000517:prevention & control; D008928:Mitochondria / Q000473:pathology*; D015995:Prevalence; D012307:Risk Factors; D014803:Vitamin B Complex / Q000627:therapeutic use*
chemical_list: D019380:Anti-HIV Agents; D007773:Lactates; D014803:Vitamin B Complex