A high incidence of nucleoside reverse transcriptase inhibitor (NRTI)-induced lactic acidosis in HIV-infected patients in a South African context.
OBJECTIVE
To determine the incidence of and predisposing risk factors for lactic acidosis in HIV-infected patients on antiretroviral drugs in South Africa.


METHODS
Observational case series.


METHODS
Sinikithemba HIV Clinic, McCord Hospital, Durban.


METHODS
Eight hundred and ninety-one HIV-positive patients on highly active antiretroviral therapy (HAART) during an 18-month period commencing in January 2004.


RESULTS
Fourteen cases of lactic acidosis (incidence rate of 19 (95% confidence interval (CI): 9-29) cases per 1,000 person-years of treatment) were reported. All cases were female, with a median age of 36 years and a median weight of 81 kg. The median time on HAART before developing lactic acidosis was 7.5 months and the median peak lactate level was 9.3 mmol/l. All cases were on stavudine (d4T), lamivudine (3TC) and 1 non-NRTI. The case mortality rate was 29% (4 patients).


CONCLUSIONS
The incidence rate is higher than reported in studies in developed countries. This may be due to d4T, which is recommended as a first-line antiretroviral drug in South Africa. This implication raises the question whether it is an appropriate drug in first-line treatment of patients with predisposing risk factors such as female gender and being overweight.
Geddes
Rosemary
R
School of Family and Public Health Medicine, University of KwaZulu-Natal, Durban. Geddes@ukzn.ac.za
Knight
Stephen
S
Moosa
Mahomed Yunus Suleman
MY
Reddi
Anand
A
Uebel
Kerry
K
Sunpath
Henry
H
D000140:Acidosis, Lactic / Q000139:chemically induced* / Q000453:epidemiology*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D015992:Body Mass Index; D015984:Causality; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects*; D012737:Sex Factors; D013019:South Africa
D018894:Reverse Transcriptase Inhibitors