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- 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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Last updated: August 2, 2017
Moore, Richard D. "Lactic Acidosis." Johns Hopkins HIV Guide, 2017. Johns Hopkins Guide, www.hopkinsguides.com/hopkins/view/Johns_Hopkins_HIV_Guide/545115/all/Lactic_Acidosis.
Moore RD. Lactic Acidosis. Johns Hopkins HIV Guide. 2017. https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_HIV_Guide/545115/all/Lactic_Acidosis. Accessed November 16, 2019.
Moore, R. D. (2017). Lactic Acidosis. In Johns Hopkins HIV Guide. Available from https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_HIV_Guide/545115/all/Lactic_Acidosis
Moore RD. Lactic Acidosis [Internet]. In: Johns Hopkins HIV Guide. ; 2017. [cited 2019 November 16]. Available from: https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_HIV_Guide/545115/all/Lactic_Acidosis.
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