Journal Article

Risk Factors for Lactic Acidosis in HIV-Infected Patients Treated with Nucleoside Reverse-Transcriptase Inhibitors: A Case-Control Study

F. Bonnet, M. Bonarek, P. Morlat, P. Mercié, M. Dupon, M. C. Gemain, D. Malvy, N. Bernard, J. L. Pellegrin and J. Beylot

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 36, issue 10, pages 1324-1328
Published in print May 2003 | ISSN: 1058-4838
Published online May 2003 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/374601
Risk Factors for Lactic Acidosis in HIV-Infected Patients Treated with Nucleoside Reverse-Transcriptase Inhibitors: A Case-Control Study

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A case-control study was undertaken to determine risk factors for lactic acidosis in human immunodeficiancy virus-infected patients treated with nucleoside reverse-transcriptase inhibitors (NRTIs). From May 1996 to June 2000, 9 patients with lactic acidosis (defined as a plasma lactic acid level of >5 mM and plasma pH of <7.38) were identified. Control patients were randomly selected from among a large cohort of patients who initiated a dual NRTI regimen in 1996 or after. Two factors were associated with an increased risk of lactic acidosis: first, a creatinine clearance of <70 mL/min before lactic acidosis (OR, 15.8 [range, 3.0–86.5], P < 10-4), and, second, a low nadir CD4+ T lymphocyte count before the inception of NRTI therapy (OR, 8.4 [range, 1.2–∞], P = .03). The total cumulative exposure to NRTIs was not associated with an increased risk of lactic acidosis, nor was the cumulative exposure to any of the 4 NRTIs studied. According to these results, monitoring of creatinine clearance, especially in patients with a low nadir CD4+ T lymphocyte count, could lead to modifications in antiretroviral therapy in order to diminish the risk of occurrence of lactic acidosis.

Journal Article.  2552 words.  Illustrated.

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

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