Lactic acidosis associated with nucleoside analog therapy in an HIV-positive patient

A 44-year-old African-American female, HIV positive treated with highly active antiretroviral therapy (HAART), consisting of two nucleoside analogues and one nonnucleoside reverse transcriptase inhibitor, who was initially admitted with severe lactic acidosis. Liver biopsy was performed on the ninth hospital day, which revealed moderate microvesicular and macrovesicular fatty changes. The possible mechanism of lactic acidosis in patients on nucleoside analogues is discussed. The question as to how to monitor for this syndrome, as usual tests are neither sensitive nor specific, still remains important.