Symptomatic lactic acidosis in hospitalized antiretroviral-treated patients with human immunodeficiency virus infection: A report of 12 cases

We retrospectively investigated the clinical and histopathologic features o f hospitalized patients infected with human immunodeficiency virus who had symptomatic lactic acidosis syndrome at a university teaching hospital duri ng 1995-2000. Twelve patients were identified, 11 during 1998-2000; of thes e, 5 died with rapid progression to otherwise unexplained multiple-organ fa ilure. All had extensive prior exposure to nucleoside analog reverse-transc riptase inhibitors (NRTIs). At presentation, the most commonly identified N RTI component of antiretroviral regimens was stavudine plus didanosine. Ele ven patients presented with abdominal pain, nausea, and/or emesis. Eight pa tients had prior acute weight loss (mean [+/- SD],12 +/- 5.3 kg). Median ve nous plasma lactate levels were greater than or equal to2-fold greater than the upper limit of normal (2.1 mmol/L). Serum transaminase levels were nea r normal limits at presentation. Histopathologic studies confirmed hepatic macrovesicular and microvesicular steatosis in 6 patients. Concurrent chemi cal pancreatitis was identified in 6 patients. The increasing number of cas es identified during the study period suggests that physicians better recog nize symptomatic lactic acidosis and/or that cumulative NRTI exposure may i ncrease the risk for this syndrome.