title: Fatal Tenofovir-Associateacd Lactic Acidosis: A Case Report.
abstract: BACKGROUND
  The introduction of highly active antiretroviral therapy (HAART), in 1996, has resulted in marked reductions in the rate of illness and death, due to HIV infection. The HAART has transformed HIV infection into a manageable chronic disease. However, although many regimens lower plasma viral load, to below the limit of detection, in most patients, maintaining viral load suppression remains challenging, because of adverse effects and toxicity in the long term, which can lead to non-adherence, virologic failure and drug resistance. Although rare, lactic acidosis often develops fatal complications, as reported in several human immunodeficiency virus infected patients treated with nucleoside reverse transcriptase inhibitors (NRTIs). The purpose of this paper is to report a case of tenofovir induced lactic acidosis and review the literature.
  
  
  METHODS
  A 52-year-old Malay gentleman, with hepatitis C virus and HIV infection was admitted to the intensive care unit for severe lactic acidosis, with concurrent Escherichia coli bacteremia with multiorgan dysfunction. The patient was started on highly active antiretroviral therapy, which included tenofovir, 5 weeks before presentation. Antimicrobial therapy, continuous veno-venous hemofiltration, and other supportive treatments were instituted. However, the patient eventually succumbed to his illness.
  
  
  CONCLUSIONS
  It is essential for clinicians to be able to recognize the signs and symptoms of lactic acidosis in NRTIs treated HIV patients, as an early diagnosis is important to institute treatment.
authors.affiliation: Department of Medicine, Hospital Putrajaya, Putrajaya, Malaysia.
authors.forename: Hasriza
authors.initials: H
authors.lastname: Hashim
authors.affiliation: Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.
authors.forename: Narisa Sulaiman
authors.initials: NS
authors.lastname: Sahari
authors.affiliation: Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.
authors.forename: Sazlyna Mohd
authors.initials: SM
authors.lastname: Sazlly Lim
authors.affiliation: Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.
authors.forename: Fan Kee
authors.initials: FK
authors.lastname: Hoo
keywords: Acidosis; Antiretroviral Therapy; Highly Active; Lactic; Nucleosides; Tenofovir; Transcriptase