Marceau et al identified risk factors for elevated serum lactic acid levels in HIV-positive patients. These can help identify patients who should be monitored more closely to avoid complications. The authors are from the University Hospital of Clermont-Ferrand in France.


Patients with concurrent diseases associated with an elevated lactic acid concentration (ischemia, heart disease, liver disease, malignancy, etc.) were excluded from the study.


The significant risk factor for hyperlactatemia was therapy with stavudine, especially in combination with didanosine (both NRTIs = nucleoside reverse transcriptase inhibitors).


Therapy with buprenorphine (a potent opioid analgesic) was a significant risk factor, but was only used in 7 of the 282 patients in the study. This may be a marker for other conditions resulting in significant pain. It is unclear to me if the risk is due to buprenorphine itself or the need for opioid analgesia).


Other factors found on multivariate analysis:

(1) age (statistically significant with p = 0.01, but odds ratio only 1.04)

(2) weight loss > 10% (but this level of weight loss is a defining feature for lactic acidosis so would not be a predictive risk factor)


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