Skip Navigation LinksHome > April 13, 2001 - Volume 15 - Issue 6 > Management of hyperlactatemia: no need for routine lactate m...
AIDS:
Editorial Comment

Management of hyperlactatemia: no need for routine lactate measurements

Brinkman, Kees

Free Access
Article Outline
Collapse Box

Author Information

From the Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.

Received: 12 February 2001; accepted: 13 February 2001.

Requests for reprints to: Kees Brinkman, MD PhD, Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM Amsterdam, the Netherlands. E-mail: k.brinkman@olvg.nl

Despite the impressively beneficial effects of antiretroviral medication for HIV-infected patients, it has become increasingly evident that prolonged therapy can also have adverse effects. One of the most fearful is the development of severe lactic acidosis, induced by the mitochondrial toxicity of nucleoside analogue reverse transcriptase inhibitors (NRTIs) [1]. Although initially believed to be an extremely rare event [2], recent studies demonstrated elevated serum lactate levels in asymptomatic patients receiving NRTIs [3–5], with an estimated incidence of between 15 and 35%. Without longitudinal studies it is not known whether severe NRTI-induced lactic acidosis (serum lactate level greater than 5 mmol/l, with a serum bicarbonate level lower than 20 mmol/l) is preceded by periods of mild hyperlactatemia (serum lactate levels between 2 and 5 mmol/l). It is possible that both represent the extremes of a single syndrome, because recent reports have appeared on patients with mild hyperlactatemia with symptoms similar to those of patients with lactic acidosis, including extreme fatigue, vomiting and abdominal pain [6,7].

In this issue of AIDS, John et al. [8] present the first, prospectively conducted, longitudinal study on the aspects of hyperlactatemia. Their study confirms the significant increase in serum lactate levels after the initiation of NRTIs, although it is unclear why patients who start NRTIs have lower lactate levels (0.74 versus 1.34 mmol/l) than antiretroviral-naive patients. An important observation in their study is the finding that lactate levels seem to stabilize for a prolonged period after the initial increase. In the one patient developing lactic acidosis, with previous lactate values, no gradual increase was observed. The authors therefore conclude that severe lactic acidosis can develop without previous, asymptomatic hyperlactatemia. Unfortunately, they do not emphasize this conclusion by commenting on the pattern of lactate increase in the five patients whose treatments were switched because of symptomatic hyperlactatemia.

The frequently cited estimated frequency of lactic acidosis (1.2 cases/1000 person years) by Fortgang et al. [2] was established in a period when NRTI monotherapy was the standard and clearly needs adjustment; in the study by John et al. [8] the incidence was 3.9/1000 person years. If the five cases of symptomatic hyperlactatemia are included as a prelude to severe lactic acidosis, the frequency would increase to 13.6/1000 patient years, which corresponds surprisingly well to the figure estimated by Lonergan et al. [9] for symptomatic hyperlactatemia (14.5/1000 patient years). Although this incidence is still not high, it appears to be increasing. Whether this is caused by an intensification of antiretroviral therapy or the use of more toxic NRTIs (such as stavudine) is not clear.

One of the most important messages from the study by John et al. [8] was the fact that mild hyperlactatemia, found in asymptomatic patients, appears to have a poor positive predictive value for the development of lactic acidosis. That study does not therefore endorse routine measurement in all NRTI-treated patients, which is in accordance with our own observations [5].

When then should lactate be measured? Currently, it seems prudent to advise lactate measurement only in those patients presenting with extreme fatigue, sudden weight loss, (vague) abdominal pain, unexplained nausea and vomiting, or sudden dyspnoea. For the interpretation of a lactate value, the attached algorithm can be followed (Fig. 1). The interruption of NRTIs remains the safest option in cases of severe hyperlactatemia and lactic acidosis, whether or not combined with supportive treatments (such as riboflavin or l-carnithine) [10]. Changing NRTIs (such as switching from stavudine to abacavir) might be a reasonable alternative in less severe cases, although this will not be feasible for every patient. Similar switches can be tried during cautious rechallenging after a temporary interruption [9]. Using these procedures, symptomatic hyperlactatemia may become a feature that can be handled, although these strategies need to be confirmed in properly conducted, prospective studies. Meanwhile, routine lactate measurements in asymptomatic patients should be avoided, because they do not provide predictive information, and could lead to unnecessary treatment alterations.

Fig. 1
Fig. 1
Image Tools
Back to Top | Article Outline

References

1. Brinkman K, ter Hofstede HJ. Mitochondrial toxicity of nucleoside analogue reverse transcriptase inhibitors: lactic acidosis, risk factors and therapeutic options. AIDS Rev 1999, 1: 141 –148.

2. Fortgang IS, Belitsos PC, Chaisson RE, Moore RD. Hepatomegaly and steatosis in HIV-infected patients receiving nucleoside analog antiretroviral therapy. Am J Gastroenterol 1995, 90: 1433 –1436.

3. Boubaker K, Sudre P, Flepp M, et al. Hyperlactatemia and antiretroviral therapy in the Swiss HIV Cohort Study (SHCS). 7th Conference on Retroviruses and Opportunistic Infections. San Francisco, 2000 [Abstract 57].

4. Harris M, Tesiorowski A, Montaner J. Screening for nucleoside-associated lactic acidosis. XIIIth International AIDS Conference. Durban, South Africa 2000 [Abstract TuPp1233].

5. Vrouenraets S, Treskes M, Regez RM, et al. Hyperlactatemia in HIV-infected patients: the role of NRTI treatment. 8th Conference on Retroviruses and Opportunistic Infections. Chicago, 2001 [Abstract 625].

6. Lonergan JT, Behling C, Pfander H, Hassanein TI, Mathews WC. Hyperlactatemia and hepatic abnormalities in ten HIV-infected patients receiving nucleoside combination regimens. Clin Infect Dis 2000, 31: 162 –166.

7. Gérard Y, Maulin L, Yazdanpanah Y. et al. Symptomatic hyperlactataemia: an emerging complication of antiretroviral therapy. AIDS 2000, 14: 2723 –2730.

8. John M, Moore CB, James IR, Nolan D, Upton RP, McKinnon EJ, Mallal SA. Chronic hyperlactatemia in HIV infected patients on antiretroviral therapy. AIDS 2001, 6: 717 –723.

9. Lonergan JT, Havlir DV, Barber E, Mathews WC. Incidence and outcome of hyperlactatemia associated with clinical manifestations in HIV-infected adults receiving NRTI-containing regimens. 8th Conference on Retroviruses and Opportunistic Infections. Chicago, 2001 [Abstract 624].

10. Brinkman K, Vrouenraets S, Kauffmann R, Weigel HM, Frissen PHJ. Treatment of nucleoside reverse transcriptase inhibitor-induced lactic acidosis. AIDS 2000, 14: 2801 –2802.

Cited By:

This article has been cited 67 time(s).

Antiviral Therapy
Asymptomatic hyperlactataemia: predictive value, natural history and correlates
McComsey, GA; Yau, L
Antiviral Therapy, 9(2): 205-212.

Medicina Clinica
Treatment of symptomatic hyperlactatemia and lactic acidosis in HIV+ patients under nucleoside reverse transcriptase inhibitors
Pedrol, E; Ribell, M; Deig, E; Villa, MDC; Miro, O; Garrabou, G; Soler, A
Medicina Clinica, 125(6): 201-204.

Clinical Journal of the American Society of Nephrology
Highly active antiretroviral therapy and the kidney: An update on antiretroviral medications for nephrologists
Berns, JS; Kasbekar, N
Clinical Journal of the American Society of Nephrology, 1(1): 117-129.
10.2215/CJN.00370705
CrossRef
Netherlands Journal of Medicine
Antiretroviral therapy in HIV patients: aspects of metabolic complications and mitochondrial toxicity
ter Hofstede, HJM; Burger, DM; Koopmans, PP
Netherlands Journal of Medicine, 61(): 393-403.

Annales De Biologie Clinique
Hyperlactatemia and lipodystrophy in HIV-positive persons
Marceau, G; Jacomet, C; Ughetto, S; Roszyk, L; Dastugue, B; Laurichesse, H; Sapin, V
Annales De Biologie Clinique, 62(4): 471-478.

Pediatrics
Serum lactate levels in infants exposed peripartum to antiretroviral agents to prevent mother-to-child transmission of HIV: Agence Nationale de Recherches Sur le SIDA et les Hepatites Virales 1209 Study, Abidjan, Ivory Coast
Ekouevi, DK; Toure, R; Becquet, R; Viho, I; Sakarovitch, C; Rouet, F; Towne-Gold, B; Fassinou, P; Leroy, V; Blanche, S; Dabis, F
Pediatrics, 118(4): E1071-E1077.
10.1542/peds.2006-0371
CrossRef
Journal of Infection
HIV-associated upodystrophy syndrome: Assessment and management
Bodasing, N; Fox, R
Journal of Infection, 46(2): 87-93.
10.1053/jinf.2002.1103
CrossRef
Hiv Clinical Trials
First-line therapy and mitochondrial damage: Different nucleosides, different findings
Blanco, F; Garcia-Benayas, T; de la Cruz, JJ; Gonzalez-Lahoz, J; Soriano, V
Hiv Clinical Trials, 4(1): 11-19.

Hepatology
Interferon and ribavirin combination therapy for chronic hepatitis C in human immunodeficiency virus-infected patients with congenital coagulation disorders
Sauleda, S; Juarez, A; Esteban, JI; Altisent, C; Ruiz, I; Puig, L; Esteban, R; Guardia, J
Hepatology, 34(5): 1035-1040.

Canadian Medical Association Journal
Symptomatic hyperlactatemia in an HIV-positive patient: a case report and discussion
Antoniou, T; Weisdorf, T; Gough, K
Canadian Medical Association Journal, 168(2): 195-198.

Therapie
Hyperlactataemia during antiretroviral therapy: Incidences, clinical data and treatment
Gerard, Y; Viget, N; Yazdanpanah, Y; Ajana, F; de la Tribonniere, X; Bocket, L; Deuffic-Burban, S; Dos Santos, A; Ballester, L; Mouton, Y
Therapie, 58(2): 153-158.

Antiviral Therapy
Complications associated with NRTI therapy: update on clinical features, and possible pathogenic mechanisms
Nolan, D; Mallal, S
Antiviral Therapy, 9(6): 849-863.

Clinical Infectious Diseases
Risk factors for and outcome of hyperlactatemia in HIV-infected persons: Is there a need for routine lactate monitoring?
Imhof, A; Ledergerber, B; Gunthard, HF; Haupts, S; Weber, R
Clinical Infectious Diseases, 41(5): 721-728.

Clinical Infectious Diseases
Primary Care Guidelines for the Management of Persons Infected with Human Immunodeficiency Virus: 2009 Update by the HIV Medicine Association of the Infectious Diseases Society of America
Aberg, JA; Kaplan, JE; Libman, H; Emmanuel, P; Anderson, JR; Stone, VE; Oleske, JM; Currier, JS; Gallant, JE
Clinical Infectious Diseases, 49(5): 651-681.
10.1086/605292
CrossRef
Journal of Medical Virology
Gender and long-term metabolic toxicities from antiretroviral therapy in HIV-1 infected persons
Boulassel, MR; Morales, R; Murphy, T; Lalonde, RG; Klein, MB
Journal of Medical Virology, 78(9): 1158-1163.
10.1002/jmv.20676
CrossRef
Hiv Clinical Trials
Mild to moderate symptoms do not correlate with lactate levels in HIV-positive patients on nucleoside reverse transcriptase inhibitors
Tan, D; Walmsley, S; Shen, S; Raboud, J
Hiv Clinical Trials, 7(3): 107-115.

AIDS
Hyperlactataemia and lactic acidosis during antiretroviral therapy: relevance, reproducibility and possible risk factors
Moyle, GJ; Datta, D; Mandalia, S; Morlese, J; Asboe, D; Gazzard, BG
AIDS, 16(): 1341-1349.

Clinical Nutrition
Hyperlactataemia and lactic acidosis in HIV-infected patients receiving antiretroviral therapy
Calza, L; Manfredi, R; Chiodo, F
Clinical Nutrition, 24(1): 5-15.
10.1016/j.clnu.2004.03.009
CrossRef
Revue Neurologique
Mitochondrial cytopathies associated with HIV infection
Gerard, Y; Melliez, H; Mouton, Y; Yazdanpanah, Y
Revue Neurologique, 162(1): 62-70.

Mitochondrion
Mitochondrial dysfunction in AIDS and its treatment
Gerschenson, M; Brinkman, K
Mitochondrion, 4(): 763-777.
10.1016/j.mito.2004.07.025
CrossRef
Jaids-Journal of Acquired Immune Deficiency Syndromes
Mitochondrial toxicity in the era of HAART: Evaluating venous lactate and peripheral blood mitochondrial DNA in HIV-infected patients taking antiretroviral therapy
Montaner, JSG; Cote, HCF; Harris, M; Hogg, RS; Yip, B; Chan, JW; Harrigan, PR; O'Shaughnessy, MV
Jaids-Journal of Acquired Immune Deficiency Syndromes, 34(): S85-S90.

Expert Opinion on Drug Metabolism & Toxicology
Apoptosis: a clinically useful measure of antiretroviral drug toxicity?
Hooker, DJ; Cherry, CL
Expert Opinion on Drug Metabolism & Toxicology, 5(): 1543-1553.
10.1517/17425250903282781
CrossRef
Lancet
Liver failure after long-term nucleoside antiretroviral therapy
Kronenberg, A; Riehle, HM; Gunthard, HF
Lancet, 358(): 759-760.

Clinical Infectious Diseases
Lactacidemia in asymptomatic HIV-infected subjects receiving nucleoside reverse-transcriptase inhibitors
Boffito, M; Marietti, G; Audagnotto, S; Raiter, R; Di Perri, G
Clinical Infectious Diseases, 34(4): 558-559.

Antiviral Therapy
Hyperlactataemia in HIV-infected patients: the role of NRTI-treatment
Vrouenraets, SME; Treskes, M; Regez, RM; Troost, N; Smulders, YM; Weigel, HM; Frissen, PHJ; Brinkman, K
Antiviral Therapy, 7(4): 239-244.

Clinical Infectious Diseases
Primary care guidelines for the management of persons infected with human immunodeficiency virus: Recommendations of the HIV Medicine Association of the Infectious Diseases Society of America
Aberg, JA; Gallant, JE; Anderson, J; Oleske, JM; Libman, H; Currier, JS; Stone, VE; Kaplan, JE
Clinical Infectious Diseases, 39(5): 609-629.

Critical Care
Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill
Khosravani, H; Shahpori, R; Stelfox, HT; Kirkpatrick, AW; Laupland, KB
Critical Care, 13(3): -.
ARTN R90
CrossRef
Infection
Lipodystrophy syndrome by HAART in HIV-Infected patients: Manifestation, mechanisms and management
Hirsch, HH; Battegay, M
Infection, 30(5): 293-298.
10.1007/s15010-002-3044-7
CrossRef
Scandinavian Journal of Infectious Diseases
Natural history of hyperlactataemia in human immunodeficiency virus-1-infected patients during highly active antiretroviral therapy
Huynh, TK; Luttichau, HR; Roge, BT; Gerstoft, J
Scandinavian Journal of Infectious Diseases, 35(1): 62-66.
10.1080/0036554021000026992
CrossRef
Lancet Infectious Diseases
Hyperlactataemia syndromes associated with HIV therapy
Ogedegbe, AEO; Thomas, DL; Diehl, AM
Lancet Infectious Diseases, 3(6): 329-337.

Expert Opinion on Pharmacotherapy
Lactic acidosis related to nucleoside therapy in HIV-infected patients
Falco, V; Crespo, M; Ribera, E
Expert Opinion on Pharmacotherapy, 4(8): 1321-1329.

Pediatrics
Hyperlactatemia in human immunodeficiency virus-uninfected infants who are exposed to antiretrovirals
Noguera, A; Fortuny, C; Munoz-Almagro, C; Sanchez, E; Vilaseca, MA; Artuch, R; Pou, J; Jimenez, R
Pediatrics, 114(5): E598-E603.
10.1542/peds.2004-0955
CrossRef
Current Pharmaceutical Design
Hepatotoxicity of antiretroviral drugs
Abrescia, N; D'Abbraccio, M; Figoni, M; Busto, A; Maddaloni, A; De Marco, M
Current Pharmaceutical Design, 11(): 3697-3710.

Journal of Antimicrobial Chemotherapy
[C-13]methionine breath test: a novel method to detect antiretroviral drug-related mitochondrial toxicity
Milazzo, L; Piazza, M; Sangaletti, O; Gatti, N; Cappelletti, A; Adorni, F; Antinori, S; Galli, M; Moroni, M; Riva, A
Journal of Antimicrobial Chemotherapy, 55(1): 84-89.
10.1093/jac/dkh497
CrossRef
AIDS
Lactate levels in children with HIV/AIDS on highly active antiretroviral therapy
Desai, N; Mathur, M; Weedon, J
AIDS, 17(): 1565-1568.
10.1097/01.aids.0000076262.76134.36
CrossRef
Clinical Infectious Diseases
Nucleoside-related mitochondrial toxicity among HIV-Infected patients receiving antiretroviral therapy: Insights from the evaluation of venous lactic acid and peripheral blood mitochondrial DNA
Montaner, JSG; Cote, HCF; Harris, M; Hogg, RS; Yip, B; Harrigan, PR; O'Shaughnessy, MV
Clinical Infectious Diseases, 38(): S73-S79.

Laboratory Investigation
Prospective evaluation of blood concentration of mitochondrial DNA as a marker of toxicity in 157 consecutively recruited untreated or HAART-treated HIV-positive patients
Chiappini, F; Teicher, E; Saffroy, R; Pham, P; Falissard, B; Barrier, A; Chevalier, S; Debuire, B; Vittecoq, D; Lemoine, A
Laboratory Investigation, 84(7): 908-914.

Revista Clinica Espanola
Symptomatic hyperlactatemia associated with the use of antiretroviral agents
Sierra, JO; Garcia, RR; Lopez-Medrano, F; de Lucia, AM; Vela, MI
Revista Clinica Espanola, 202(): 540-542.

Antiviral Therapy
Nucleoside analogues toxicities related to mitochondrial dysfunction: focus on HIV-infected children
Vigano, A; Giacomet, V
Antiviral Therapy, 10(): M53-M64.

Scandinavian Journal of Infectious Diseases
Long term adverse effects related to nucleoside reverse transcriptase inhibitors: Clinical impact of mitochondrial toxicity
Maagaard, A; Kvale, D
Scandinavian Journal of Infectious Diseases, 41(): 808-817.
10.3109/00365540903186181
CrossRef
Clinical Infectious Diseases
Severe nucleoside-associated lactic acidosis in human immunodeficiency virus-infected patients: Report of 12 cases and review of the literature
Falco, V; Rodriguez, D; Ribera, E; Martinez, E; Miro, JM; Domingo, P; Diazaraque, R; Arribas, JR; Gonzalez-Garcia, JJ; Montero, F; Sanchez, L; Pahissa, A
Clinical Infectious Diseases, 34(6): 838-846.

Clinical Chemistry
Frequency, risk factors, and outcome of hyperlactatemia in HIV-positive persons: Implications for the management of treated patients
Marceau, G; Sapin, V; Jacomet, C; Ughetto, S; Cormerais, L; Regagnon, C; Dastugue, B; Peigue-Lafeuille, H; Beytout, J; Laurichesse, H
Clinical Chemistry, 49(7): 1154-1162.

AIDS
Frequency, risk factors and features of hyperlactatemia in a large number of patients undergoing antiretroviral therapy
Manfredi, R; Motta, R; Patrono, D; Calza, L; Chiodo, F; Boni, P
AIDS, 17(): 2131-2133.

Journal of Clinical Virology
Serum L-lactate and pyruvate in HIV-infected patients with and without presumed NRTI-related adverse events compared to healthy volunteers
ter Hofstede, HJM; Willems, HL; Koopmans, PP
Journal of Clinical Virology, 29(1): 44-50.
10.1016/S1386-6532(03)00085-4
CrossRef
AIDS
Safety and efficacy of switching to alternative nucleoside analogues following symptomatic hyperlactatemia and lactic acidosis
Lonergan, JT; Barber, RE; Mathews, WC
AIDS, 17(): 2495-2499.

Canadian Medical Association Journal
HIV drug stavudine (Zerit, d4T) and symptoms mimicking Guillain-Barre syndrome
Wooltorton, E
Canadian Medical Association Journal, 166(8): 1067.

Antiviral Therapy
Mitochondrial effects of a 24-week course of pegylated-interferon plus ribavirin in asymptomatic HCV/HIV co-infected patients on long-term treatment with didanosine, stavudine or both
Ballesteros, AL; Miro, O; Lopez, S; Fuster, D; Videla, S; Martinez, E; Garrabou, R; Salas, A; Cote, H; Tor, J; Rey-Joly, C; Planas, R; Clotet, B; Tural, C
Antiviral Therapy, 9(6): 969-977.

Toxicological Sciences
Erythrocebus patas monkey offspring exposed perinatally to NRTIs sustain skeletal muscle mitochondrial compromise at birth and at 1 year of age
Divi, RL; Leonard, SL; Walker, BL; Kuo, MM; Shockley, ME; St Claire, MC; Nagashima, K; Harbaugh, SW; Harbaugh, JW; Poirier, MC
Toxicological Sciences, 99(1): 203-213.
10.1093/toxsci/kfm143
CrossRef
Canadian Journal of Infectious Diseases & Medical Microbiology
Management and treatment of hepatitis C virus in patients with HIV and hepatitis C virus coinfection: A practical guide for health care professionals
Cote, P; Baril, JG; Hebert, MN; Klein, M; Lalonde, R; Poliquin, M; Rouleau, D; Therrien, R; Vezina, S; Willems, B; Dion, H; Junod, P; Lapointe, N; Levesque, D; Pinault, L; Tremblay, C; Trottier, B; Trottier, S; Tsoukas, C; Piche, A
Canadian Journal of Infectious Diseases & Medical Microbiology, 18(5): 293-303.

American Journal of Health-System Pharmacy
Identification, management, and prevention of adverse effects associated with highly active antiretroviral therapy
Schiller, DS
American Journal of Health-System Pharmacy, 61(): 2507-2522.

Hiv Medicine
Depletion of mitochondrial DNA copies/cell in peripheral blood mononuclear cells in HIV-1-infected treatment-naive patients
Maagaard, A; Holberg-Petersen, M; Kvittingen, EA; Sandvik, L; Bruun, JN
Hiv Medicine, 7(1): 53-58.

Journal of Human Virology
Chronic stavudine exposure induces hepatic mitochondrial toxicity in adult Erythrocebus patas monkeys
Gerschenson, M; Nguyen, VT; St Claire, MC; Harbaugh, SW; Harbaugh, JW; Proia, LA; Poirier, MC
Journal of Human Virology, 4(6): 335-342.
10.1097/01.GHV.000019968.51560.90
CrossRef
Medicina Clinica
Lactic acidosis following antiretroviral therapy
Moreno-Cuerda, VJ; Garcia, RR
Medicina Clinica, 125(6): 213-214.

Medicina Clinica
Antiretroviral treatment associated life-threatening adverse events
Moreno-Cuerda, VJ; Morales-Conejo, M; Rubio, R
Medicina Clinica, 126(): 744-749.

Expert Opinion on Drug Safety
Metabolic complications associated with antiretroviral therapy in HIV-infected and HIV-exposed uninfected paediatric patients
Vigano, A; Cerini, C; Pattarino, G; Fasan, S; Zuccotti, GV
Expert Opinion on Drug Safety, 9(3): 431-445.
10.1517/14740330903579991
CrossRef
Mitochondrion
Mitochondrial dysfunction and antiretroviral nucleoside analog toxicities: what is the evidence?
Dagan, T; Sable, C; Bray, J; Gerschenson, M
Mitochondrion, 1(5): 397-412.
PII S1567-7249(02)00003-X
CrossRef
Mitochondrion
Mitochondrial injury in the pathogenesis of antiretroviral-induced hepatic steatosis and lactic acidemia
Day, L; Shikuma, C; Gerschenson, M
Mitochondrion, 4(): 95-109.
10.1016/j.mito.2004.06.011
CrossRef
New England Journal of Medicine
Changes in mitochondrial DNA as a marker of nucleoside toxicity in HIV-infected patients
Cote, HCF; Brumme, ZL; Craib, KJP; Alexander, CS; Wynhoven, B; Ting, LL; Wong, H; Harris, M; Harrigan, PR; O'Shaughnessy, MV; Montaner, JSG
New England Journal of Medicine, 346(): 811-820.

AIDS
Antiretroviral nucleoside and nucleotide analogues and mitochondria
Cossarizza, A; Moyle, G
AIDS, 18(2): 137-151.

PDF (283)
AIDS
Case report: nucleoside analogue-induced lactic acidosis in the third trimester of pregnancy
Mandelbrot, L; Kermarrec, N; Marcollet, A; Lafanechère, A; Longuet, P; Chosidow, D; Saada, M
AIDS, 17(2): 272-273.

AIDS
Mitochondrial damage and DNA depletion in cord blood and umbilical cord from infants exposed in utero to Combivir
Divi, RL; Walker, VE; Wade, NA; Nagashima, K; Seilkop, SK; Adams, ME; Nesel, CJ; O'Neill, JP; Abrams, EJ; Poirier, MC
AIDS, 18(7): 1013-1021.

PDF (319)
Current Opinion in Infectious Diseases
Hyperlactatemia syndromes in people with HIV infection
John, M; Mallal, S
Current Opinion in Infectious Diseases, 15(1): 23-29.

PDF (132)
JAIDS Journal of Acquired Immune Deficiency Syndromes
Long-Term Mitochondrial Toxicity in HIV-Uninfected Infants Born to HIV-Infected Mothers
Nguyen, V; Walker, B; Landay, AL; Walker, VE; Charurat, M; Blattner, WA; for the Women and Infants Transmission Study (WITS) Group, ; Poirier, MC; Divi, RL; Al-Harthi, L; Olivero, OA
JAIDS Journal of Acquired Immune Deficiency Syndromes, 33(2): 175-183.

PDF (6269)
JAIDS Journal of Acquired Immune Deficiency Syndromes
Lack of Recurrence of Hyperlactatemia in HIV-Infected Patients Switched From Stavudine to Abacavir or Zidovudine
Lonergan, JT; McComsey, GA; Fisher, RL; Shalit, P; File, TM; Ward, DJ; Williams, VC; Hessenthaler, SM; Lindsey, L; Hernandez, JE; for the ESS40010 (TARHEEL) Study Team,
JAIDS Journal of Acquired Immune Deficiency Syndromes, 36(4): 935-942.

PDF (176)
JAIDS Journal of Acquired Immune Deficiency Syndromes
Lipid Oxidative Markers Are Significantly Increased in Lipoatrophy But Not in Sustained Asymptomatic Hyperlactatemia
McComsey, GA; Morrow, JD
JAIDS Journal of Acquired Immune Deficiency Syndromes, 34(1): 45-49.

PDF (245)
The Pediatric Infectious Disease Journal
Fatal lactic acidosis and mimicking Guillain-Barré syndrome in an adolescent with human immunodeficiency virus infection
Rosso, R; Di Biagio, A; Ferrazin, A; Bassetti, M; Ciravegna, BW; Bassetti, D
The Pediatric Infectious Disease Journal, 22(7): 668-670.

PDF (129)
The Pediatric Infectious Disease Journal
Hyperlactatemia in human immunodeficiency virus-infected children receiving antiretroviral treatment
JIMÉNEZ, R; NOGUERA, A; FORTUNY, C; SANCHEZ, E; ARTUCH, R; VILASECA, MA; MUÑOZ-ALMAGRO, C; POU, J
The Pediatric Infectious Disease Journal, 22(9): 778-782.

PDF (68)
Back to Top | Article Outline
Keywords:

Hyperlactatemia; lactic acidosis; nucleoside analogue reverse transcriptase inhibitors

© 2001 Lippincott Williams & Wilkins, Inc.

Login

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.