|
|
 |
Summary
and Conclusions
| •
|
Occurs
in ~20% of patients on NRTI therapy; majority do not develop
lactic acidosis
|
| •
|
Serial
measurement of lactate levels in asymptomatic patients has not
been shown to be clinically useful
|
| •
|
Rechallenge
with >2 NRTIs for >6 months may be successful
|
| •
|
d4T
may be replaced with ABC, ZDV, or both
|
| •
|
Recovery
may be prolonged (Mean: 62 days; Range 7 - 176 days)
|
•
In conclusion, hyperlactatemia occurs in approximately 20% of patients
receiving NRTI therapy. The vast majority of such cases, however,
do not develop lactic acidosis.
• There are no data supporting the clinical utility of serial
measurement of lactate levels in asymptomatic patients. As such, this
should not be done on a routine basis.
• Lonergan and colleagues have rechallenged 17 patients with
two or more new NRTIs over six months or more.1 This has been successful
in all 17 patients without symptomatic hyperlactatemia developing
again.
• The d4T component of the regimen may be replaced with abacavir,
zidovudine, or a combination of the two.
• Complete recovery may take time; in this study, the range was
seven to 176 days, with a mean of 62 days.
Reference:
1. Longergan JT, Havlir D, Behling C et al. Incidence and outcome
of hyperlactatemia associated with clinical manifestations in HIV-infected
adults receiving NRTI-containing regimens. Program and abstracts of
the 8th Conference on Retroviruses and Opportunistic Infections, Chicago,
IL; February 4-8, 2001. Abstract 624.
|
|
|
|
