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Lactic acidosis in an HIV-infected patient receiving highly active antiretroviral therapy

Nature Clinical Practice Nephrology volume 2, pages 109–114 (2006)Cite this article

Abstract

Background A 51-year-old man with HIV infection on highly active antiretroviral therapy presented with abdominal pain and exertional dyspnea. Physical examination revealed increased respiration and cachexia. Laboratory tests showed a lactic acid concentration elevated to 6.4 mM.

Investigation Physical examination, blood chemistry, arterial blood gas, urine analysis, chest X-ray, and ultrasound of liver.

Diagnosis Nucleoside reverse transcriptase inhibitor (NRTI)-induced lactic acidosis, hepatitis and chemical pancreatitis. Proximal renal tubular acidosis with Fanconi's syndrome, secondary to treatment with tenofovir.

Management The patient was supported on intravenous and oral bicarbonate, riboflavin and phosphorus supplementation. Highly active antiretroviral therapy was discontinued. The patient's lactate level decreased about 2 weeks after discharge.

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Figure 1: Differential diagnosis of anion gap metabolic acidosis.
Figure 2: Mechanisms of nucleoside reverse transcriptase inhibitor (NRTI)-induced lactic acidosis.

References

  1. Falco V et al. (2002) Severe nucleoside-associated lactic acidosis in HIV-infected patients: report of 12 cases and review of the literature. Clin Infect Dis 34: 838–846

    Article  Google Scholar 

  2. Fortgang IS et al. (1995) Hepatomegaly and steatosis in HIV-infected patients receiving nucleoside analog antiretroviral therapy. Am J Gastroenterol 90: 1433–1466

    CAS  PubMed  Google Scholar 

  3. Lonergan JT et al. (2000) Hyperlactatemia and hepatic abnormalities in 10 HIV-infected patients receiving nucleoside combination regimens. Clin Infect Dis 31: 162–166

    Article  CAS  Google Scholar 

  4. Huynh TK et al. J (2003) Natural history of hyperlactatemia in HIV-1-infected patients during HAART. Scand J Infect Dis 35: 62–66

    Article  CAS  Google Scholar 

  5. Claessens YE et al. (2003) Bench to bedside review: severe lactic acidosis in HIV patients treated with nucleoside analogue reverse transcriptase inhibitors. Critical Care 7: 226–232

    Article  Google Scholar 

  6. Côté HC et al. (2002) Changes in mitochondrial DNA as a marker of nucleoside toxicity in HIV-infected patients. N Engl J Med 346: 811–820

    Article  Google Scholar 

  7. Hood VL and Tannen RL (1998) Production of acid-base balance by pH regulation of acid production. N Engl J Med 339: 819–826

    Article  CAS  Google Scholar 

  8. Hocqueloux L et al. (2003) Prevalence, risk factors and outcome of hyperlactataemia in HIV-infected patients. HIV Med 4: 18–23

    Article  CAS  Google Scholar 

  9. Bonnet F et al. (2003) Risk factors for lactic acidosis in HIV-infected patients treated with nucleoside reverse transcriptase inhibitors: a case control study. Clin Infect Dis 36: 1324–1328

    Article  CAS  Google Scholar 

  10. Chodock R et al. (1999) Survival of a human immunodeficiency patient with nucleoside-induced lactic acidosis—role of haemodialysis treatment. Nephrol Dial Transplant 14: 2484–2486

    Article  CAS  Google Scholar 

  11. Earle KE et al. (2004) Fanconi's syndrome in HIV+ adults: report of three cases and literature review. J Bone Miner Res 19: 714–721

    Article  Google Scholar 

  12. Moretti S et al. (1998) Effect of L-carnitine on human immunodeficiency virus-1 infection-associated apoptosis: a pilot study. Blood 91: 3817–3824

    CAS  PubMed  Google Scholar 

  13. Claessens YE et al. (2003) Detecting life-threatening lactic acidosis related to nucleoside-analog treatment of human immunodeficiency virus-infected patients, and treatment with L-carnitine. Crit Care Med 31: 1042–1047

    Article  CAS  Google Scholar 

  14. McComsey GA and Lederman MM (2002) High doses of riboflavin and thiamine may help in secondary prevention of hyperlactatemia. AIDS Read 12: 222–224

    PubMed  Google Scholar 

  15. Lonergan JT et al. (2003) Safety and efficacy of switching to alternative nucleoside analogues following symptomatic hyperlactatemia and lactic acidosis. AIDS 17: 2495–2499

    Article  CAS  Google Scholar 

  16. Brinkman K et al. (1999) Mitochondrial toxicity induced by nucleoside-analogue reverse-transcriptase inhibitors is a key factor in the pathogenesis of antiretroviral-therapy-related lipodystrophy. Lancet 354: 1112–1115

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

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Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Vishal Patel

  2. Division of Nephrology, Department of Medicine, Veterans Affairs North Texas Healthcare System, Dallas, TX, USA

    S Susan Hedayati

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  1. Vishal Patel
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  2. S Susan Hedayati
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Correspondence to S Susan Hedayati.

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Patel, V., Hedayati, S. Lactic acidosis in an HIV-infected patient receiving highly active antiretroviral therapy. Nat Rev Nephrol 2, 109–114 (2006). https://doi.org/10.1038/ncpneph0102

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