Severe hyperlactataemia complicating stavudine first-line antiretroviral therapy in South Africa.

Hdl Handle:
http://hdl.handle.net/10144/41770
Title:
Severe hyperlactataemia complicating stavudine first-line antiretroviral therapy in South Africa.
Authors:
Stead, D; Osler, M; Boulle, A; Rebe, K; Meintjes, G
Journal:
Antiviral therapy
Abstract:
BACKGROUND: In the public sector antiretroviral therapy (ART) programme in South Africa the standardized first-line regimen includes stavudine (d4T). Severe symptomatic hyperlactataemia (SHL) is a potentially life-threatening complication of d4T. METHODS: GF Jooste Hospital is a referral centre for six ART clinics. We retrospectively reviewed cases referred with lactate levels > or =5 mmol/l that were attributed to nucleoside reverse transcriptase inhibitors from August 2003 to November 2005. We calculated cumulative ART exposure in patients attending these clinics to derive a referral rate. RESULTS: In total, 75 patients were referred with severe SHL (71 female). All had been on d4T and on ART for a median of 10 months. The referral rate for severe SHL was 17.5 cases per 1,000 patient-years. In 53 patients (71%), lactic acidosis (standard bicarbonate [SHCO3] <20 mmol/l) was confirmed, resulting in a referral rate of 12.3 cases per 1,000 patient-years. Twelve patients (16%) died during acute admission (< or =30 days). SHCO3 <15 mmol/l and pH < 7.2 were the only factors associated with acute mortality (odds ratio [OR] 22.5, 95% confidence interval [CI] 2.8-1,045.7 and OR 13.9, 95% CI 2.7-86.9, respectively). A total of 30 less severe cases were rechallenged with zidovudine without recurrence of SHL. CONCLUSIONS: This study confirms a high incidence of severe SHL in Africa, which has been shown in previous studies. Rechallenge with zidovudine in less severe cases was found to be safe.
Affiliation:
GF Jooste Hospital, Cape Town, South Africa. davestead@mweb.co.za
Issue Date:
Nov-2008
URI:
http://hdl.handle.net/10144/41770
PubMed ID:
19043928
Additional Links:
http://www.intmedpress.com
Language:
en
ISSN:
1359-6535
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorStead, D-
dc.contributor.authorOsler, M-
dc.contributor.authorBoulle, A-
dc.contributor.authorRebe, K-
dc.contributor.authorMeintjes, G-
dc.date.accessioned2008-12-03T14:28:45Z-
dc.date.available2008-12-03T14:28:45Z-
dc.date.issued2008-11-
dc.identifier.citationSevere hyperlactataemia complicating stavudine first-line antiretroviral therapy in South Africa. 2008, 13 (7):937-43 Antivir. Ther. (Lond.)en
dc.identifier.issn1359-6535-
dc.identifier.pmid19043928-
dc.identifier.urihttp://hdl.handle.net/10144/41770-
dc.description.abstractBACKGROUND: In the public sector antiretroviral therapy (ART) programme in South Africa the standardized first-line regimen includes stavudine (d4T). Severe symptomatic hyperlactataemia (SHL) is a potentially life-threatening complication of d4T. METHODS: GF Jooste Hospital is a referral centre for six ART clinics. We retrospectively reviewed cases referred with lactate levels > or =5 mmol/l that were attributed to nucleoside reverse transcriptase inhibitors from August 2003 to November 2005. We calculated cumulative ART exposure in patients attending these clinics to derive a referral rate. RESULTS: In total, 75 patients were referred with severe SHL (71 female). All had been on d4T and on ART for a median of 10 months. The referral rate for severe SHL was 17.5 cases per 1,000 patient-years. In 53 patients (71%), lactic acidosis (standard bicarbonate [SHCO3] <20 mmol/l) was confirmed, resulting in a referral rate of 12.3 cases per 1,000 patient-years. Twelve patients (16%) died during acute admission (< or =30 days). SHCO3 <15 mmol/l and pH < 7.2 were the only factors associated with acute mortality (odds ratio [OR] 22.5, 95% confidence interval [CI] 2.8-1,045.7 and OR 13.9, 95% CI 2.7-86.9, respectively). A total of 30 less severe cases were rechallenged with zidovudine without recurrence of SHL. CONCLUSIONS: This study confirms a high incidence of severe SHL in Africa, which has been shown in previous studies. Rechallenge with zidovudine in less severe cases was found to be safe.en
dc.language.isoenen
dc.relation.urlhttp://www.intmedpress.comen
dc.rightsArchived on this site with kind permission of International Medical Press. http://www.intmedpress.comen
dc.titleSevere hyperlactataemia complicating stavudine first-line antiretroviral therapy in South Africa.en
dc.contributor.departmentGF Jooste Hospital, Cape Town, South Africa. davestead@mweb.co.zaen
dc.identifier.journalAntiviral therapyen
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