Lactic acidosis associated with nucleoside analog therapy in an HIV-positive patient

A 44-year-old African-American female, HIV positive treated with highly act ive antiretroviral therapy (HAART), consisting of two nucleoside analogues and one nonnucleoside reverse transcriptase inhibitor, who was initially ad mitted with severe lactic acidosis. Liver biopsy was performed on the ninth hospital day, which revealed moderate microvesicular and macrovesicular fa tty changes. The possible mechanism of lactic acidosis in patients on nucle oside analogues is discussed. The question as to how to monitor for this sy ndrome, as usual tests are neither sensitive nor specific, still remains im portant.