[Fatty liver and increased serum lactate in a woman with HIV]

A 50-year-old woman with HIV who had undergone a 7-month course of antiretroviral treatment (stavudine, lamivudine, indinavir, ritonavir) was admitted to hospital with abdominal pain, nausea, vomiting and muscle pain. Physical examination revealed subfebrile body temperature and hepatomegaly.

Biochemical tests revealed moderate elevations of gamma GT, AST and ALT as well as marked hyperlactatemia. Abdominal computed tomography indicated pronounced hepatomegaly. Percutaneous liver biopsy was performed and demonstrated macro- and microvesicular hepatic steatosis on light microscopy. Electron microscopy showed mitochondrial damage.

Despite discontinuation of antiretroviral treatment serum lactate levels further increased initially and clinical symptoms were progressive. In the following weeks, a slow but steady recovery of laboratory values and physical condition was noted.

Hyperlactataemia associated with abdominal pain can indicate the mitochondrial toxicity due to nucleoside reverse transcriptase inhibitors. After drug discontinuation, improvement of clinical symptoms and laboratory values is often delayed, frequently for several weeks.