We report a case of severe lactic acidosis in an human immunodeficiency vir
us (HIV)-infected patient treated with combination regimen of stavudine, di
danosine and nevirapine. Antiretroviral nucleoside analogs are inhibitors o
f mitochondrial DNA polymerase gamma, resulting in the dysfunction of the m
itochondrial respiratory chain. Despite symptomatic treatments and intraven
ous L-carnitine supplementation, lactic acidosis persisted, leading to mult
iorgan failure. The patient died 7 days after admission to the intensive ca
re unit. Retrospective analysis of published cases showed neither specific
nor predictive signs of outcome that is usually fatal, with no effective th
erapy to date. We therefore recommend determining blood lactate in patients
with onset of unexplained general fatigue or digestive signs and to stop a
ll antiretroviral treatments in the case of lactate increase. (C) 2000 Edit
ions scientifiques et medicales Elsevier SAS.