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

• Published in: Clinical infectious diseases Vol. 36; no. 10; pp. 1324 - 1328
• Main Authors: Bonnet, F., Bonarek, M., Morlat, P., Mercié, P., Dupon, M., Gemain, M. C., Malvy, D., Bernard, N., Pellegrin, J. L., Beylot, J.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 15-05-2003; University of Chicago Press
• Subjects: Acidosis, Lactic - chemically induced; Acidosis, Lactic - epidemiology; Adult; Antiretrovirals; Biological and medical sciences; Case-Control Studies; Didanosine - adverse effects; Didanosine - therapeutic use; Drug toxicity and drugs side effects treatment; Female; Hepatitis B; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV/AIDS; Human viral diseases; Humans; Infections; Infectious diseases; Kidney failure; Lactic acidosis; Male; Medical sciences; Middle Aged; Miscellaneous (drug allergy, mutagens, teratogens...); Nadir; Nucleosides; Pharmacology. Drug treatments; Predisposing factors; Renal clearance; Reverse Transcriptase Inhibitors - adverse effects; Reverse Transcriptase Inhibitors - therapeutic use; Risk Factors; Stavudine - adverse effects; Stavudine - therapeutic use; T lymphocytes; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Human; Immunopathology; Toxicity; AIDS; Case control study; Immune deficiency; Infection; Viral disease; Reverse transcriptase inhibitor; Risk factor; Nucleosidic analog; Lactic acid; Metabolic acidosis
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/374601

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.