Important note: Information in this article was accurate in June 2003. The state of the art June have changed since the publication date. |
AIDSWEEKLY Plus; Monday, June 30, 2003
Michael Greer, Senior Medical Writer
Fabrice Bonnet and colleagues at Hopital Saint-Andre and Hopital Pellegrin in Bordeaux, Hopital Haut-Leveque in Pessac, and the Centre Hospitalier de la Cote Basque in Bayonne investigated these risk factors in a groups of patients undergoing treatment with nucleoside reverse transcriptase inhibitors (NRTIs).
Low creatinine clearance was the most significant factor associated with lactic acidosis development, Bonnet and coauthors found.
Creatinine clearance of less than 70 mL/minute was linked to an almost 16-fold increase in lactic acidosis risk, they said. In addition, a low trough CD4 cell count before the initiation of NRTI treatment heightened lactic acidosis risk by more than eightfold.
The extent of NRTI therapy had little if any impact on lactic acidosis risk, study data showed. Neither total cumulative NRTI exposure nor exposure to any individual drug was significantly associated with lactic acidosis development.
Lactic acidosis was definied as a plasma lactic acid level of less than 5 mM with a plasma pH of less than 7.38 (Risk factors for lactic acidosis in HIV-infected patients treated with nucleoside reverse-transcriptase inhibitors: a case-control study. Clin Infect Dis. 2003 May 15;36(10):1324-8.
"According to these results, monitoring of creatinine clearance, especially in patients with a low nadir CD4+ T lymphocyte count, could lead to modifications in antiretroviral therapy in order to diminish the risk of occurrence of lactic acidosis," Bonnet and colleagues concluded.
The corresponding author for this report is Fabrice Bonnet, Federation de Medecine Interne, Maladies Infectieuses et Pathologies Tropicales, Hopital Saint-Andre, Bordeaux, France. E-mail: fabrice.bonnet@chu-bordeaux.fr.
Key points reported in this study include:
Low creatinine clearance is a risk factor for lactic acidosis during nucleoside reverse transcriptase inhibitor (NRTI) treatment
Patients with creatinine clearance of less than 70 mL/minute were almost 16 times more likely to develop lactic acidosis
Low CD4 cell counts also contributed to lactic acidosis risk
This article was prepared by AIDS Weekly editors from staff and other reports.
Reference
Bonnet F, Bonarek M, Morlat P, et al., "Risk factors for lactic acidosis in HIV-infected patients treated with nucleoside reverse-transcriptase inhibitors: a case-control study", Clin Infect Dis. 2003 May 15;36(10):1324-8.
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