The role of nucleoside reverse transcriptase inhibitors usage in the incidence of hyperlactatemia and lactic acidosis in HIV/AIDS patients
The role of nucleoside reverse transcriptase inhibitors usage in the incidence of hyperlactatemia and lactic acidosis in HIV/AIDS patients
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DOI：
10.1016/j.biopha.2011.09.016
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发表时间：
2012-06-01
影响因子：
7.5
通讯作者：
Jevtovic, Djordje
中科院分区：
文献类型：
--
作者：
Dragovic, Gordana;Jevtovic, Djordje
高乳酸血症和乳酸性酸中毒（LA）是在一些核苷类逆转录酶抑制剂（NRTIs）治疗期间发生的最危险和危及生命的副作用，主要是二腺苷（ddI）和司他夫定（d4T），也称为d-药物。因此，我们进行了一项前瞻性随访研究，旨在检查每种NRTI的高乳酸血症和LA的发病率（IR）和发病率比（RR）。396名hiv患者被纳入最终分析，包括783.8人年的随访。在2000年1月1日至2008年1月1日期间，记录了19例高乳酸血症和15例LA。在对发生高乳酸血症和LA有显著影响的方案中，最低的IR是双氨甘苷组（IR = 2.87 / 100人-年，95% CI = 0.45-9.25, IR = 4.31 / 100人-年，95% CI = 1.07-13.91），最高的是双氨甘苷+司他夫定组（IR = 10.17 / 100人-年，95% CI = 1.02-19.76, IR = 7.39 / 100人-年，95% CI = 1.02-13.05）。与单独使用司他夫定相比，司他夫定的高乳酸血症RR为2.67 (95% CI = 1.11-12.52)，司他夫定联合使用司他夫定的RR为4.06 （95% CI = 1.31-15.48）。司他夫定与单用司他夫定相比，LA的RR为3.12 (95% CI = 1.13-10.65)，二腺苷+司他夫定与单用二腺苷相比的RR为5.13 （95% CI = 1.54-13.37）。其他AP的危险因素是CD4细胞计数低于200个/mm(3)和女性。我们的研究结果表明，司他夫定单独使用或与二腺苷联合使用不应作为一线治疗，特别是在CD4细胞计数低于200细胞/mm3的患者和女性患者中，如果有其他治疗选择的话。(C) 2012 Elsevier Masson SAS。版权所有。
Hyperlactatemia and lactic acidosis (LA) are among the most dangerous and life-threatening side effect that occurs during therapy with some nucleoside reverse transcriptase inhibitors (NRTIs), mainly didanosine (ddI) and stavudine (d4T), also known as d-drugs. Therefore, we performed a prospective, follow-up study and aimed to examine the incidence rates (IR) and rate ratios (RR) of hyperlactatemia and LA for each NRTI. Three hundred and ninety-six HIV-patients were included in final analysis comprising 783.8 person-years of follow-up. Between 1st January 2000 and 1st January 2008, 19 cases of hyperlactatemia and 15 cases of LA were recorded. Between regimens with the significant impact for developing hyperlactatemia and LA the lowest IR was for didanosine (IR = 2.87 per 100 person-years, 95% CI = 0.45-9.25 and IR = 4.31 per 100 person-years, 95% CI = 1.07-13.91, respectively), and the highest for didanosine + stavudine (IR = 10.17 per 100 person-years, 95% CI = 1.02-19.76 and IR = 7.39 per 100 person-years, 95% CI = 1.02-13.05, respectively). Compared to didanosine alone the RR of hyperlactatemia was 2.67 (95% CI = 1.11-12.52) for stavudine, and 4.06 (95% CI = 1.31-15.48) for didanosine + stavudine. The RR of LA was 3.12 (95% CI = 1.13-10.65) for stavudine, and 5.13 (95% CI = 1.54-13.37) for didanosine + stavudine in comparison with didanosine alone. Other risk factors for AP were CD4 cell count less than 200 cells/mm(3) and female sex. Our results suggest that the use of stavudine alone or in combination with didanosine should not be used as first-line therapy, especially in patients with CD4 cell count less than 200 cells/mm3 and females if other treatment options are available. (C) 2012 Elsevier Masson SAS. All rights reserved.