Lactacidemia in Asymptomatic HIV-Infected Subjects Receiving Nucleoside Reverse-Transcriptase Inhibitors

Open Access
Publisher Website
Google Scholar
Abstract
SIR—As the duration of survival increases for HIV-infected patients receiving highly active antiretroviral therapy [1], much more attention is being paid to short- and long-term toxicity resulting from the use of antiretrovirals. Mitochondrial toxicity has been identified as the common denominator in a group of side effects associated with the use of nucleoside reverse-transcriptase inhibitors (NRTIs) [2]. The most severe clinical form of NRTI toxicity is extreme, life-threatening hyperlactacidemia [3]. This is extremely rare, but milder and asymptomatic forms in patients with less-elevated lactate levels are increasingly being documented [4]. According to recent studies, it seems that, in the vast majority of patients, milder or asymptomatic hyperlactacidemia does not progress to more-severe clinical forms and, therefore, routine measurement of lactate levels in NRTI recipients is not necessary [5]. However, the duration of follow-up was short in the prospective studies performed so far, and no definitive data are available on possible cumulative, very long-term side effects.