Journal Article

Symptomatic Lactic Acidosis in Hospitalized Antiretroviral-Treated Patients with Human Immunodeficiency Virus Infection: A Report of 12 Cases

Michael E. Coghlan, Jean-Pierre Sommadossi, Nirag C. Jhala, J. Many Wickliffe, S. Saag Michael and Victoria A. Johnson

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 33, issue 11, pages 1914-1921
Published in print December 2001 | ISSN: 1058-4838
Published online December 2001 | e-ISSN: 1537-6591 | DOI: https://dx.doi.org/10.1086/323783
Symptomatic Lactic Acidosis in Hospitalized Antiretroviral-Treated Patients with Human Immunodeficiency Virus Infection: A Report of 12 Cases

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We retrospectively investigated the clinical and histopathologic features of hospitalized patients infected with human immunodeficiency virus who had symptomatic lactic acidosis syndrome at a university teaching hospital during 1995–2000. Twelve patients were identified, 11 during 1998–2000; of these, 5 died with rapid progression to otherwise unexplained multiple-organ failure. All had extensive prior exposure to nucleoside analog reverse-transcriptase inhibitors (NRTIs). At presentation, the most commonly identified NRTI component of antiretroviral regimens was stavudine plus didanosine. Eleven patients presented with abdominal pain, nausea, and/or emesis. Eight patients had prior acute weight loss (mean [±SD], 12 ± 5.3 kg). Median venous plasma lactate levels were ≥2-fold greater than the upper limit of normal (2.1 mmol/L). Serum transaminase levels were near normal limits at presentation. Histopathologic studies confirmed hepatic macrovesicular and microvesicular steatosis in 6 patients. Concurrent chemical pancreatitis was identified in 6 patients. The increasing number of cases identified during the study period suggests that physicians better recognize symptomatic lactic acidosis and/or that cumulative NRTI exposure may increase the risk for this syndrome.

Journal Article.  4658 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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