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Hyperlactataemia syndromes associated with HIV therapy
Anthony Emmanuel O Ogedegbe1, David L Thomas, Anna Mae Diehl
1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA.
The Lancet. Infectious Diseases
|June 5, 2003
Summary
Nucleoside-analogue reverse transcriptase inhibitors (NRTIs) can cause hyperlactataemia in HIV patients. While often mild, it can lead to severe lactic acidosis syndrome, requiring further research into its causes and management.
Area of Science:
- Biochemistry
- Pharmacology
- Infectious Diseases
Background:
- Hyperlactataemia affects 8-18.3% of HIV patients on nucleoside-analogue reverse transcriptase inhibitors (NRTIs).
- Episodes are typically transient and subclinical, but severe lactic acidosis syndrome can occur.
- Proposed mechanism involves NRTI inhibition of mitochondrial DNA polymerase, affecting oxidative phosphorylation and lactate homeostasis.
Purpose of the Study:
- To review current literature on NRTI-related hyperlactataemia.
- To identify controversies and areas needing further investigation.
- To address future research directions for understanding pathogenesis, predisposing factors, and management.
Main Methods:
- Literature review of published studies on NRTI-related hyperlactataemia.
- Analysis of epidemiological data and proposed pathomechanisms.
- Identification of knowledge gaps and areas of scientific debate.
Main Results:
- Most NRTI-related hyperlactataemia cases are transient and subclinical.
- Symptomatic cases can present as severe lactic acidosis syndrome with metabolic acidosis and hepatic steatosis.
- Significant progress made in understanding the natural history, but pathogenesis and management require further study.
Conclusions:
- NRTI-induced hyperlactataemia is a significant concern in HIV management.
- Understanding pathogenesis, predisposing factors, and optimal management strategies is crucial.
- Further research is needed to address current knowledge gaps and improve patient outcomes.