Fatal portal hypertension, liver failure and Mitochondrial dysfunction after HIV-1 nucleoside analogue-induced hepatitis and lactic acidemia [Carr A et al. Lancet 2001; 357: 1412]:The authors present a patient who developed lactic acidosis with acute hepatitis ascribed to mitochondrial toxicity. Antiretroviral therapy was stopped, and liver tests returned to normal within 3-5 months. Eighteen months later, the patient presented with portal hypertension and liver failure with no obvious cause other than persistent mitochondrial toxicity, which was supported by EM exam. The authors conclude that NRTIs may cause chronic low-level lactic acidaemia with asymptomatic progressive liver disease.
Comment: This is an anecdotal case, but one that may be important in terms of understanding the consequences of mitochondrial toxicity from NRTIs. The authors recommend routine monitoring of liver function tests in persons who receive nucleosides, especially in those who have previously had lactic acidemia. This is contrary to the recommendations given by Andrew Carr, the first author of this paper, at the 8th CROI in February 2001, when he summarized the state-of-the-art on mitochondrial toxicity.
posted 6/20/2001

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