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Hyperlactatemia in HIV Positive Patients: Is There a Need for Routine
Lactate Monitoring?
Lactic
acidosis is a rare but life-threatening complication of
combination antiretroviral therapy (CART). Asymptomatic or mildly
symptomatic episodes of hyperlactatemia are more frequent, but
their clinical relevance is unknown.
The
incidences of, risk factors for, and courses of hyperlactatemia
and lactic acidosis were prospectively assessed in the following
3 groups at the Zurich center of the Swiss HIV Cohort Study:
Persons already receiving CART at baseline;
Treatment-naive
persons who initiated CART during the observation period; and
Persons who received no CART before or during the observation period.
Results
During
4788 person-years of follow-up, a total of 22,678 lactate assessments
were performed for 1566 persons;
662
(42.3%) had at least 1 lactate level measurement of > 2.4 mmol/L,
and 49 (3.1%) had severe hyperlactatemia (lactate level of >
5.0 mmol/L).
The
incidence of hyperlactatemia was 227 cases and 59 cases per 1000
person-years of follow-up among persons with and persons without
CART, respectively.
During
the observation period, the incidence decreased from 459 cases to
85 cases per 1000 person-years of follow-up, respectively, because
of changing CART prescription patterns.
Severe
hyperlactatemia occurred in treated persons only. In multivariable
Cox proportional hazards models, significant risk factors for severe
hyperlactatemia were regimens containing stavudine
(Zerit)
and didanosine
(Videx) and regimens containing
efavirenz
(Sustiva).
Lactic
acidosis was diagnosed in 4 of 1566 persons, all of whom were receiving
stavudine and didanosine.
Conclusions
Hyperlactatemia
was frequently observed in all 3 groups, but severe hyperlactatemia
and lactic acidosis were rarely observed among persons who received
CART.
Lactate
monitoring appears to be indicated primarily for persons receiving
stavudine and didanosine and for persons who are symptomatic.
Long-term
follow-up is needed to investigate the risk of novel treatment regimens
for hyperlactatemia.
Division of Infectious
Diseases and Hospital Epidemiology, University Hospital Zurich,
Switzerland.
08/12/05
Reference
A
Imhof and others (The Swiss HIV Cohort Study). Risk factors for
and outcome of hyperlactatemia in HIV-infected persons: is there
a need for routine lactate monitoring? Clinical
Infectious Diseases 41(5): 721-728. September
2005. Epub Jul 29, 2005.
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