Hyperlactatemia and hepatic abnormalities in 10 human immunodeficiency virus-infected patients receiving nucleoside analogue combination regimens

During a 6-and-a-half month period, we identified 10 human immunodeficiency virus (HIV)-infected men who were receiving antiretroviral regimens, inclu ding nucleoside analogues, and who developed unexplained reproducible hyper lactatemia in association with either abdominal symptoms or an unaccounted- for elevated alanine aminotransferase level, or both. After careful conside ration of the possible etiologies, antiretrovirals were discontinued; lacta te levels normalized in all patients. The estimated incidence of this pheno menon in our clinic was 20.9 cases per 1000 person-years of nucleoside anal ogue treatment. These observations extend the spectrum of the nucleoside an alogue-induced lactic acidosis/hepatic steatosis syndrome by the identifica tion of a subtle and perhaps earlier form, which has characteristic symptom s and laboratory abnormalities, and a favorable prognosis on discontinuatio n of antiretroviral therapy.