Fatal lactic acidosis during antiretroviral therapy

Area of Science:

• Pediatric critical care medicine
• Infectious diseases
• Pharmacology

Background:

• Antiretroviral therapy (ART) is standard for managing human immunodeficiency virus (HIV) infection in children.
• Mitochondrial dysfunction is a known, albeit rare, complication of certain nucleoside reverse transcriptase inhibitors used in ART.
• Type B lactic acidosis is a metabolic derangement associated with mitochondrial toxicity.

Observation:

• A 5-year-old girl with HIV infection on a regimen including ritonavir, stavudine, and didanosine presented with severe lactic acidosis.
• The patient experienced worsening symptoms including nausea, vomiting, and rising serum lactate levels.
• Despite intensive supportive care, including alkali administration and hemodiafiltration, the acidosis proved fatal.

Findings:

• This case represents the first reported instance of fatal lactic acidosis in a pediatric patient receiving antiretroviral therapy.
• The patient's clinical presentation and laboratory findings were consistent with severe mitochondrial dysfunction secondary to ART.
• The specific combination of antiretroviral drugs may have contributed to the observed toxicity.

Implications:

• Fatal lactic acidosis is a potential, previously unreported complication of ART in pediatric HIV patients.
• Prompt identification of mitochondrial dysfunction is critical for timely intervention and potentially preventing fatal outcomes.
• Further research into ART-associated mitochondrial toxicity in pediatric populations is warranted.