Frequency, Risk Factors, and Outcome of Hyperlactatemia in HIV-positive Persons: Implications for the Management of Treated Patients

• Published in: Clinical chemistry (Baltimore, Md.) Md.), 2003-07, Vol.49 (7), p.1154-1162
• Main Authors: Marceau, Geoffroy, Sapin, Vincent, Jacomet, Christine, Ughetto, Sylvie, Cormerais, Louis, Regagnon, Christel, Dastugue, Bernard, Peigue-Lafeuille, Helene, Beytout, Jean, Laurichesse, Henri
• Format: Article
• Language: English
• Subjects: Acidosis, Lactic - chemically induced; Acidosis, Lactic - drug therapy; Acidosis, Lactic - epidemiology; Adult; Anti-HIV Agents - adverse effects; Antiretroviral agents; Biological and medical sciences; Blood; Cross-Sectional Studies; Drug Therapy, Combination; Female; HIV Seropositivity - drug therapy; Human viral diseases; Humans; Infectious diseases; Lactic Acid - blood; Male; Medical sciences; Metabolic disorders; Population studies; Prospective Studies; Protease Inhibitors - adverse effects; Regression Analysis; Reverse Transcriptase Inhibitors - adverse effects; Risk Factors; Treatment Outcome; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 0009-9147; 1530-8561
• DOI: 10.1373/49.7.1154

The nucleoside reverse transcriptase inhibitors used for the treatment of HIV-positive persons are now clearly associated with metabolic disorders. We determined the prevalence of and risk factors for hyperlactatemia in HIV-positive persons to assess the relevance of lactate venous blood concentrations during antiretroviral therapy. We conducted a prospective cross-sectional study of venous lactate determinations with 282 consecutive HIV-positive persons who, in addition to a physical examination, had blood samples taken every 3-4 months for routine biochemical, immunologic, and viral assessment. The frequencies of hyperlactatemia and lactic acidosis were determined, and the risk factors were analyzed by a multivariate logistic regression model. The effect of modification of antiretroviral therapy in patients with moderate hyperlactatemia was also assessed. From 782 blood lactate determinations, we identified 65 (23%) patients with moderate hyperlactatemia and 5 (1.8%) with lactate concentrations >5 mmol/L (2 with severe lactic acidosis; 0.7%). Older age, drug regimens containing stavudine [adjusted odds ratio (OR) = 2.5] or a combination of stavudine-didanosine (adjusted OR = 3.1), and the use of buprenorphine (adjusted OR = 14.7) were independent predictors of hyperlactatemia. Among 65 patients with moderate hyperlactatemia, 39 did not have their treatments changed, and 26 had a new combination therapy that was associated with a clinical improvement and a more pronounced decrease in lactate (-1.66 vs -0.99 mmol/L; P