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. 2010 Sep;26(9):991-5.
doi: 10.1089/aid.2009.0309.

Short communication: Severe symptomatic hyperlactatemia among HIV type 1-infected adults on antiretroviral therapy in Côte d'Ivoire

Collaborators, Affiliations

Short communication: Severe symptomatic hyperlactatemia among HIV type 1-infected adults on antiretroviral therapy in Côte d'Ivoire

Albert Minga et al. AIDS Res Hum Retroviruses. 2010 Sep.

Abstract

Stavudine is no longer recommended for use in first-line antiretroviral therapy (ART), but it remains in high demand worldwide because it is affordable. We report the clinical presentation and incidence of severe hyperlactatemia (SL) in HIV-infected adults who initiated ART between April 2005 and May 2009 in Côte d'Ivoire, West Africa. In a prospective cohort study at the HIV care center affiliated with the National Centre for Blood Transfusion, we used standardized forms to record baseline and follow-up data. We measured serum lactate levels for all adults on ART who showed signs of hyperlactatemia. SL was defined as serum lactate >2.5 mmol/liter. Overall, 806 adults initiated ART. Among the 591 patients (73%) on stavudine-containing regimens, 394 were women (67%); the median pre-ART CD4 count was 150/mm3 and the median body mass index was 20.9 kg/m2. These patients were followed for a median of 28 months. We detected SL only among patients taking stavudine. The incidence of SL was 0.55/100 person-years (PY) (95% CI 0.47-0.63) overall and 0.85/100 PY among women (95% CI 0.75-0.95). Among the eight patients with SL, 100% lost >9% of body weight before diagnosis, 100% had serum lactate >4 mmol/liter (range 4.2-12.1), 50% had pre-ART BMI >25 kg/m2, and three patients died (38%), accounting for 6.4% of deaths among patients taking stavudine. As long as HIV clinicians continue to use stavudine in sub-Saharan Africa, they should watch out for acute unexplained weight loss in patients taking ART, particularly among women and patients with high pre-ART BMI.

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References

    1. World Health Organization. Scaling up antiretroviral therapy in resource-limited settings: Treatment guidelines for a public approach. 2003. http://www.who.int/3by5/publications/documents/arv_guidelines/en/print.html. [Sep 15;2009 ]. http://www.who.int/3by5/publications/documents/arv_guidelines/en/print.html
    1. Ogedegbe AE. Thomas DL. Diehl AM. Hyperlactataemia syndromes associated with HIV therapy. Lancet Infect Dis. 2003;3:329–337. - PubMed
    1. John M. Moore CB. James IR. Nolan D. Upton RP. McKinnon EJ. Mallal SA. Chronic hyperlactatemia in HIV-infected patients taking antiretroviral therapy. AIDS. 2001;15:717–723. - PubMed
    1. Gerard Y. Maulin L. Yazdanpanah Y. De La Tribonniere X. Amiel C. Maurage CA, et al. Symptomatic hyperlactataemia: An emerging complication of antiretroviral therapy. AIDS. 2000;14:2723–2730. - PubMed
    1. Fellay J. Boubaker K. Ledergerber B. Bernasconi E. Furrer H. Battegay M, et al. Prevalence of adverse events associated with potent antiretroviral treatment: Swiss HIV Cohort Study. Lancet. 2001;358:1322–1327. - PubMed

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