title: Risk factors for fatality in HIV-infected patients with dideoxynucleoside-induced severe hyperlactataemia or lactic acidosis.
abstract: Lactic acidosis (LA) and severe hyperlactataemia (HL) are infrequent but serious complications of antiretroviral therapy that have been associated with a high fatality rate.
  
  
  
  In a multinational retrospective cohort study, LA was defined as arterial blood pH<7.35, bicarbonate <20 mmol/l and lactate above normal, and HL as confirmed blood lactate >5 mmol/l. Logistic regression was used to identify factors associated with fatality. Sensitivity and specificity of different case definitions as predictors of death were compared.
  
  
  
  The overall case-fatality rate was 19/110 (17.3%), but among acidotic patients it was 33% (16/49 cases). There were 10 asymptomatic patients and none of them died as a consequence of the event. The median lactate for fatal, non-fatal and all patients was 8.3 mmol/l (IQR 7.2-13.1), 6.4 mmol/l (IQR 5.4-7.8) and 6.7 mmol/l (IQR 5.5-8.1), respectively. After adjusting for age and current CD4(+) T-cell count, lactate >7 mmol/l (OR 6.27, 95% CI 1.13-34.93), blood bicarbonate <12 mmol/l (OR 10.02 relative to >18 mmol/l, 95% CI 1.33-75.65) and concurrent opportunistic infections (OR 8.69, 95% CI 1.45-52.22) were independently associated with case fatality. Blood lactate >7 mmol/l showed a sensitivity of 84% for fatality with a specificity of 60%, whereas bicarbonate <12 mmol/l showed a better specificity (85%) but a poorer sensitivity (42%). Bicarbonate <18 mmol/l appears to be as good as lactate <7 mmol/l at predicting death (sensitivity 90% and specificity 54%).
  
  
  
  Our data suggest that blood lactate >7 mmol/l and blood bicarbonate <18 mmol/l appear to predict death and might help clinicians in selecting patients who may benefit from more intense monitoring.
authors: Centre for Sexual Health & HIV Research, University College London, UK. A.Arenas-Pinto@ucl.ac.uk
authors: Alejandro
authors: A
authors: Arenas-Pinto
authors: Alison
authors: A
authors: Grant
authors: Krishnan
authors: K
authors: Bhaskaran
authors: Andrew
authors: A
authors: Copas
authors: Andrew
authors: A
authors: Carr
authors: Signe W
authors: SW
authors: Worm
authors: Esteban
authors: E
authors: Martinez
authors: Peter
authors: P
authors: Reiss
authors: David
authors: D
authors: Dunn
authors: Rainer
authors: R
authors: Weber
authors: Jennifer
authors: J
authors: Hoy
authors: Ian
authors: I
authors: Weller
mesh_terms: D000140:Acidosis, Lactic / Q000097:blood / Q000139:chemically induced* / Q000401:mortality*; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects*; D015224:Dideoxynucleosides / Q000009:adverse effects*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D015497:HIV-1; D006801:Humans; D019344:Lactic Acid / Q000009:adverse effects* / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D019380:Anti-HIV Agents; D015224:Dideoxynucleosides; D019344:Lactic Acid