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A high incidence of nucleoside reverse transcriptase inhibitor (NRTI)-induced lactic acidosis in HIV-infected patients in a South African context
Abstract
Design. Observational case series.
Setting. Sinikithemba HIV Clinic, McCord Hospital, Durban.
Subjects. Eight hundred and ninety-one HIV-positive patients on highly active antiretroviral therapy (HAART) during an 18-month period commencing in January 2004.
Measurements and results. Fourteen cases of lactic acidosis (incidence rate of 19 (95% confidence interval (CI): 9 - 29) cases per 1 000 person-years of treatment) were reported. All cases were female, with a median age of 36 years and a median weight of 81 kg. The median time on HAART before developing lactic acidosis was 7.5 months and the median peak lactate level was 9.3 mmol/l. All cases were on stavudine (d4T), lamivudine (3TC) and 1 non-NRTI. The case mortality rate was 29% (4 patients).
Conclusions. The incidence rate is higher than reported in studies in developed countries. This may be due to d4T, which is recommended as a first-line antiretroviral drug in South Africa. This implication raises the question whether it is an appropriate drug in first-line treatment of patients with predisposing risk factors such as female gender and being overweight.
South African Medical Journal Vol. 96(8) 2006: 722-724
