Stavudine-induced hyperlactatemia/lactic acidosis at a tertiary communicable diseases clinic in South Africa

J Int Assoc Physicians AIDS Care (Chic). 2010 Mar-Apr;9(2):109-12. doi: 10.1177/1545109710361536.

Abstract

Objectives: To determine the incidence, presentation, and outcome of hyperlactatemia and lactic acidosis. DESIGN AND METHODS SETTING: Grey's Hospital, a tertiary level referral institution.

Study population: 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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Acidosis, Lactic / chemically induced*
  • Acidosis, Lactic / epidemiology*
  • Acidosis, Lactic / physiopathology
  • Adolescent
  • Adult
  • Aged
  • Ambulatory Care Facilities / statistics & numerical data*
  • Anti-HIV Agents / administration & dosage
  • Anti-HIV Agents / adverse effects*
  • Antiretroviral Therapy, Highly Active / adverse effects
  • Drug Therapy, Combination
  • Female
  • HIV Infections / drug therapy*
  • HIV Infections / virology
  • Humans
  • Incidence
  • Lactates / blood*
  • Male
  • Middle Aged
  • Reverse Transcriptase Inhibitors / administration & dosage
  • Reverse Transcriptase Inhibitors / adverse effects
  • Severity of Illness Index
  • South Africa / epidemiology
  • Stavudine / administration & dosage
  • Stavudine / adverse effects*
  • Young Adult

Substances

  • Anti-HIV Agents
  • Lactates
  • Reverse Transcriptase Inhibitors
  • Stavudine