Lactic acidosis and hepatic steatosis associated with use of stavudine: report of four cases

Ann Intern Med. 2000 Aug 1;133(3):192-6. doi: 10.7326/0003-4819-133-3-200008010-00010.


Background: An association between use of zidovudine and didanosine and a rare but life-threatening syndrome of hepatic steatosis, lactic acidosis, and myopathy has been reported.

Objective: To describe the syndrome of hepatic steatosis, lactic acidosis, and myopathy in four patients taking stavudine.

Design: Case series.

Setting: A community hospital in Washington, D.C., and National Institutes of Health Clinical Center, Bethesda, Maryland.

Patients: Two men and two women with HIV-1 infection who were taking stavudine presented with lactic acidosis and elevated levels of aminotransferases. All patients required intensive care.

Measurements: Levels of lactic acid, alanine aminotransferase, aspartate aminotransferase, amylase, and lipase; computed tomography of the abdomen; liver biopsy (two patients); and muscle biopsy (two patients).

Results: Histologic findings consistent with mitochondrial injury confirmed the diagnosis of hepatic or muscle abnormality.

Conclusion: Because hepatic steatosis may be life-threatening, physicians should consider it as a possible cause of elevated hepatic aminotransferase levels among patients taking stavudine.

Publication types

  • Case Reports

MeSH terms

  • Acidosis, Lactic / chemically induced*
  • Adolescent
  • Adult
  • Alanine Transaminase / blood
  • Anti-HIV Agents / adverse effects*
  • Aspartate Aminotransferases / blood
  • Biopsy
  • Drug Therapy, Combination
  • Fatty Liver / chemically induced*
  • Female
  • HIV Infections / drug therapy
  • Humans
  • Male
  • Middle Aged
  • Mitochondrial Myopathies / chemically induced
  • Muscle, Skeletal / enzymology
  • Stavudine / adverse effects*
  • Syndrome
  • Tomography, X-Ray Computed


  • Anti-HIV Agents
  • Stavudine
  • Aspartate Aminotransferases
  • Alanine Transaminase