Hyperlactataemia and lactic acidosis during antiretroviral therapy: relevance, reproducibility and possible risk factors

AIDS. 2002 Jul 5;16(10):1341-9. doi: 10.1097/00002030-200207050-00005.


Objective: To evaluate the prevalence, outcome and possible risk factors for hyperlactataemia and lactic acidosis in HIV-positive persons receiving antiretroviral therapy.

Methods: Cross-sectional and longitudinal data from a prospectively collected clinical database. Associations with antiretroviral regimen, clinical and laboratory parameters were assessed using univariate and multivariate Cox's proportional hazards model.

Results: Patients naive to therapy and patients on current therapy for a minimum of 4 months were assessed. Median lactate was 1.1 mol/l in 253 untreated individuals and 1.4 mmol/l in 1239 patients stable on therapy for at least 4 months. At least two on-therapy samples were available for 750 of the 1239 individuals, taken a median 92 days apart. Lactate measurement showed a low positive predictive value of 38.9% but a high negative predictive value (98%) for normal values. Lactate was elevated > or = 2.4 mmol/l in 102 individuals on at least one occasion. In the multivariate Cox's proportional hazards model, no demographic characteristics were associated with hyperlactataemia. Didanosine-containing regimens doubled the relative hazard of hyperlactataemia compared with those sparing didanosine. Abacavir-containing regimens reduced the hazard of hyperlactataemia. Choice of thymidine analogue did not influence risk. Hyperlactataemia was associated with acid-base disturbance. Use of didanosine and female sex were over-represented amongst nine patients with severe hyperlactataemia (> 5 mmol/l) or lactic acidosis.

Conclusions: Screening of lactate is of limited use in asymptomatic individuals on antiretroviral therapy. Raised lactate represents part of a spectrum of lactate and acid-base disturbance that infrequently includes lactic acidosis. Didanosine appears associated with an increased risk of hyperlactataemia.

Publication types

  • Comparative Study

MeSH terms

  • Acidosis, Lactic / blood
  • Acidosis, Lactic / chemically induced*
  • Acidosis, Lactic / economics
  • Adult
  • Anti-HIV Agents / adverse effects*
  • Cross-Sectional Studies
  • Didanosine / adverse effects
  • Dideoxynucleosides / therapeutic use
  • Female
  • HIV Infections / blood
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • Humans
  • Lactic Acid / blood*
  • Longitudinal Studies
  • Male
  • Multivariate Analysis
  • Prospective Studies
  • Reproducibility of Results
  • Risk Factors
  • Sex Factors
  • Thymidine / analogs & derivatives
  • Thymidine / therapeutic use


  • Anti-HIV Agents
  • Dideoxynucleosides
  • Lactic Acid
  • Didanosine
  • Thymidine
  • abacavir