Fatal lactic acidosis in an HIV-infected patient on stavudine and didanosine therapy.

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.