Severe nucleoside-associated lactic acidosis in human immunodeficiency virus-infected patients: report of 12 cases and review of the literature

Clin Infect Dis. 2002 Mar 15;34(6):838-46. doi: 10.1086/339041. Epub 2002 Feb 13.


Lactic acidosis is a rare but often fatal complication reported in some human immunodeficiency virus (HIV)-infected patients treated with nucleoside-analogue reverse-transcriptase inhibitors. We report a series of 12 patients with HIV infection treated with nucleoside analogues who developed unexplained metabolic acidosis. We have also reviewed 60 additional published cases. The aim of the present study is to describe the clinical picture, prognostic factors, and final outcome for nucleoside-associated lactic acidosis. The mortality rate is high: 33% for our patients, and 57% for the patients described in the literature. In the multivariate analysis, a lactate serum level of >10 mM (odds ratio [OR], 13.23; 95% confidence interval [CI], 2.96-59.25) was the only factor associated with higher mortality. The administration of specific therapy with cofactors against acidosis was associated with a lower mortality (OR, 0.17; 95% CI, 0.04-0.73). We conclude that specific therapy with cofactors may improve the outcome for patients with this syndrome.

MeSH terms

  • Acidosis, Lactic / etiology*
  • Acidosis, Lactic / mortality
  • Adult
  • Female
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • HIV Infections / mortality
  • Humans
  • Male
  • Middle Aged
  • Mitochondria / drug effects
  • Mitochondria / enzymology
  • Multivariate Analysis
  • Prognosis
  • Reverse Transcriptase Inhibitors / adverse effects*


  • Reverse Transcriptase Inhibitors