Chronic Hyperlactatemia in HIV-infected Patients taking antiretroviral therapy [John M et al. AIDS 2001; 15: 717]:This is a report from participants in the Western Australian HIV Cohort Study, which has 349 patients receiving NRTI therapy who had 1,379 venous lactate measurements from January 1999 through June 2000. During 516 patient-years of observation, two patients developed lactic acidosis with lactate levels above 5mmol/l, and 5 others had elevated lactate levels at 2.8 - 4.1mmol/l accompanied by nausea or abdominal pain. These patients responded to changes in NRTI treatment. Most of the patients had mild, asymptomatic elevated levels at 1.5 - 3.5mmol/l.
Comment: The frequency of hyperlactatemia in prior reports has been 1.2 - 14.5/1,000 patient years [Am J Gastroenterol 1995; 90:1433; Lonergran JT et al. 8th CROI, February 2001, Abstract 624]. The rate in this study would be 13.6/1,000 patient years. Perhaps the most important practical issue raised by this report concerns therapeutic monitoring of lactate levels. Kees Brinkman addresses this issue in the accompanying editorial [AIDS 2000; 15:795]. The recommendation is to obtain lactate measurements only in patients who present with otherwise unexplained extreme fatigue, sudden weight-loss, abdominal pain, nausea and vomiting, or dyspnea. Levels less than 2mmol/l are normal, levels of 2-5mmol/l merit "watchful waiting" with consideration of changing NRTIs. Levels above 5mmol/l, if confirmed, merit discontinuation of NRTIs with supportive treatment.
posted 6/20/2001

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