Lactic acidosis in the setting of antiretroviral therapy for the acquired immunodeficiency syndrome - A case report and review of the literature

Type B lactic acidosis, a rare but often fatal disorder, has been reported in 21 AIDS patients on antiretroviral therapy (ART). We present an AIDS pat ient with severe and prolonged lactic acidosis on stavudine and lamivudine, The lactic acidosis occurred in the absence of mitochondrial myopathy, hep atomegaly, or liver failure. This is the second report of lactic acidosis i n a patient on stavudine and lamivudine. This patient recovered after aggre ssive supportive therapy including intravenous alkali and fluid administrat ion as well as continuous venovenous hemodiafiltration, A single dose of di chloroacetate (DCA) was associated with a decrease in the serum lactate lev el by 20%, which persisted for more than 24 h. Seventeen months after recov ery, the patient was rechallenged with ART without recurrence of lactic aci dosis. We review and summarize all reported cases of patients with ART-asso ciated lactic acidosis reported in the English literature. Copyright (R) 20 00 S. Karger AG. Basel.