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PP 3.24
Elevated serum lactic acid levels during highly active antiretroviral therapy
(HAART). Frequency, possible pathogenetic causes, and potential clinical
significance
Roberto Manfredi, Leonardo Calza
Infectious Diseases, University of Bologna, Italy
Introduction
Despite the increasing evidence of hyperlactatemia as an emerging side effect of HAART,
its frequency, pathogenesis, management, outcome, and prevention are still under active
investigation.
Patients and Methods
A case-control study has been performed on over 1,000 HIV-infected patients (p) in the
years 2004-2005. When evaluating HAART-treated p with adherence levels of at least
90%, p with hyperlactacidemia were compared with p with normal lactate levels, in
relation with a broad spectrum of variables.
Results
Of the 755 evaluable p, 272 (36%) experienced at least one evidence of hyperlactacidemia
(mean value 24.7±8.8 mg/mL). Only 56 p of the study group (7.4%) experienced two
or more subsequent alterations, with progressively increasing levels in 73.2% of p, while
a grade 4 hyperlactatemia (>39.6 mg/dL) was found in five p only (0.7%). When
comparing the 272 p with elevated lactacidemia with the 483 control subjects, no
significant difference was seen as to age, gender, type of risk for HIV infection, duration
and stage of HIV disease, CD4+ lymphocyte count, HIV plasma viral load, and type and
duration of use of single and combined antiretroviral drugs (HAART). In an univariate
analysis, p with hyperlactacidemia showed a significantly longer anti-HIV therapy
(p