title: Stavudine-induced hyperlactatemia/lactic acidosis at a tertiary communicable diseases clinic in South Africa.
abstract: OBJECTIVE
  To determine the incidence, presentation, and outcome of hyperlactatemia and lactic acidosis. DESIGN AND METHODS SETTING: Grey's Hospital, a tertiary level referral institution.
  
  
  METHODS
  A chart review of 1719 patients commenced on highly active antiretroviral therapy (HAART) between August 1, 2004, and July 31, 2006. A total of 1000 patients (615 females) received stavudine (d4T)/lamivudine (3TC)/efavirenz (EFV), 719 patients (598 females) received d4T/ 3TC/nevirapine (NVP).
  
  
  RESULTS
  Of the 1719 patients, 152 (8.84%) had an elevated plasma venous lactate (>2.2 mmol/L), 45 patients required admission for lactic acidosis. The overall incidence rate was 13.5 cases per 1000 patient years. The most common presenting symptoms were loss of weight (95%), abdominal pain (78.9%), loss of appetite, and paresthesias (63.8%). The median body mass index (BMI) at commencement of HAART and at onset of symptoms was 24.5 and 26, respectively. A median serum lactate level of 6.08 mmol/L (range 2.3-19.7 mmol/L) was observed at the onset of symptoms.
  
  
  CONCLUSIONS
  High BMI at treatment initiation did not always predict hyperlactatemia. All patients who died had a baseline CD4 count <10 cells/mm(3) at HAART initiation.
authors.affiliation: Infectious Diseases Unit, Department of Medicine, Grey's Hospital, Pietermaritzburg, South Africa.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Hernández Pérez
authors.forename: Halima
authors.initials: H
authors.lastname: Dawood
mesh_terms: D000140:Acidosis, Lactic / Q000139:chemically induced* / Q000453:epidemiology* / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D015994:Incidence; D007773:Lactates / Q000097:blood*; D008297:Male; D008875:Middle Aged; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D012720:Severity of Illness Index; D013019:South Africa / Q000453:epidemiology; D018119:Stavudine / Q000008:administration & dosage / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D007773:Lactates; D018894:Reverse Transcriptase Inhibitors; D018119:Stavudine