Lactic acidosis in an HIV-infected patient receiving highly active antiretroviral therapy.
BACKGROUND
A 51-year-old man with HIV infection on highly active antiretroviral therapy presented with abdominal pain and exertional dyspnea. Physical examination revealed increased respiration and cachexia. Laboratory tests showed a lactic acid concentration elevated to 6.4 mM.


METHODS
Physical examination, blood chemistry, arterial blood gas, urine analysis, chest X-ray, and ultrasound of liver.


METHODS
Nucleoside reverse transcriptase inhibitor (NRTI)-induced lactic acidosis, hepatitis and chemical pancreatitis. Proximal renal tubular acidosis with Fanconi's syndrome, secondary to treatment with tenofovir.


RESULTS
The patient was supported on intravenous and oral bicarbonate, riboflavin and phosphorus supplementation. Highly active antiretroviral therapy was discontinued. The patient's lactate level decreased about 2 weeks after discharge.
Patel
Vishal
V
Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Hedayati
S Susan
SS
D000140:Acidosis, Lactic / Q000139:chemically induced*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged