Frequency, risk factors, and outcome of hyperlactatemia in HIV-positive persons: implications for the management of treated patients.

BACKGROUND The nucleoside reverse transcriptase inhibitors used for the treatment of HIV-positive persons are now clearly associated with metabolic disorders. We determined the prevalence of and risk factors for hyperlactatemia in HIV-positive persons to assess the relevance of lactate venous blood concentrations during antiretroviral therapy. METHODS We conducted a prospective cross-sectional study of venous lactate determinations with 282 consecutive HIV-positive persons who, in addition to a physical examination, had blood samples taken every 3-4 months for routine biochemical, immunologic, and viral assessment. The frequencies of hyperlactatemia and lactic acidosis were determined, and the risk factors were analyzed by a multivariate logistic regression model. The effect of modification of antiretroviral therapy in patients with moderate hyperlactatemia was also assessed. RESULTS From 782 blood lactate determinations, we identified 65 (23%) patients with moderate hyperlactatemia and 5 (1.8%) with lactate concentrations >5 mmol/L (2 with severe lactic acidosis; 0.7%). Older age, drug regimens containing stavudine [adjusted odds ratio (OR) = 2.5] or a combination of stavudine-didanosine (adjusted OR = 3.1), and the use of buprenorphine (adjusted OR = 14.7) were independent predictors of hyperlactatemia. Among 65 patients with moderate hyperlactatemia, 39 did not have their treatments changed, and 26 had a new combination therapy that was associated with a clinical improvement and a more pronounced decrease in lactate (-1.66 vs -0.99 mmol/L; P <0.05). CONCLUSIONS Chronic compensated and moderate hyperlactatemia was common in our population study. Measurement of lactate, under standardized conditions, may be useful in optimizing management of HIV-positive persons on antiretroviral therapy.