Lactic Acidosis

Richard D. Moore, M.D.

Lactic Acidosis is a topic covered in the Johns Hopkins HIV Guide.

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CLINICAL

Symptoms: Fatigue, weakness, myalgias, and GI distress, including abdominal pain, abdominal distention, nausea/vomiting, diarrhea. Later can advance to dyspnea, orthostasis, organ failure (hepatic, renal), cardiovascular collapse and death.
Mortality: 7% with lactate 5-10 mM, 20-30% with lactate 10-15 mM, 50-60% with lactate >15 mM
Caused by NRTI use: d4T, ddI, AZT. Does not appear to be caused by 3TC, FTC, ABC, TDF, TAF, though listed in package insert as a class effect. Use of d4T and ddI no longer recommended; occurrence now rare.
Associated with mitochondrial DNA gamma polymerase inhibition and decrease in mitochondrial DNA
May be accompanied by hepatic steatosis (fatty liver), pancreatitis. Fatal liver failure can occur (earliest reports in AZT-treated patients)
Increased risk with lower CD4, older age, female sex.

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CLINICAL

Symptoms: Fatigue, weakness, myalgias, and GI distress, including abdominal pain, abdominal distention, nausea/vomiting, diarrhea. Later can advance to dyspnea, orthostasis, organ failure (hepatic, renal), cardiovascular collapse and death.
Mortality: 7% with lactate 5-10 mM, 20-30% with lactate 10-15 mM, 50-60% with lactate >15 mM
Caused by NRTI use: d4T, ddI, AZT. Does not appear to be caused by 3TC, FTC, ABC, TDF, TAF, though listed in package insert as a class effect. Use of d4T and ddI no longer recommended; occurrence now rare.
Associated with mitochondrial DNA gamma polymerase inhibition and decrease in mitochondrial DNA
May be accompanied by hepatic steatosis (fatty liver), pancreatitis. Fatal liver failure can occur (earliest reports in AZT-treated patients)
Increased risk with lower CD4, older age, female sex.

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