A high incidence of lactic acidosis and symptomatic hyperlactatemia in women receiving highly active antiretroviral therapy in Soweto, South Africa
A high incidence of lactic acidosis and symptomatic hyperlactatemia in women receiving highly active antiretroviral therapy in Soweto, South Africa
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DOI：
10.1086/518976
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发表时间：
2007-07-15
影响因子：
11.8
通讯作者：
Karstaedt, A. S.
中科院分区：
文献类型：
--
作者：
Bolhaar, M. G.;Karstaedt, A. S.
背景乳酸酸中毒和症状性高乳酸血症可能使核苷逆转录酶抑制剂的使用复杂化。女性可能会增加这种并发症的风险。我们的研究评估了不同性别的乳酸酸中毒和症状性高乳酸血症的发生率，分析了临床特征，并描述了用齐多夫定替代司他夫定重新引入高效抗逆转录病毒治疗（HAART）的安全性。对2004年4月至2005年8月在南非索韦托开始HAART的1735名成人（其中63%为女性）进行了回顾性队列分析，随访至2006年2月。乳酸水平>= 4.5 mmol/L且除接受HAART治疗外无其他潜在原因导致乳酸酸中毒升高的患者纳入研究。共有23例患者（其中22例为女性）发生乳酸酸中毒。总发生率为10.6例/1000患者-年;女性患者的发生率为16.1例/1000患者-年，男性患者为1.2例/1000患者-年。7例（30.4%）患者死亡。HAART开始时，8例（34.8%）患者肥胖（体重指数[计算为体重（kg）除以身高（m）的平方]，130）。44例患者（其中37例为女性）有症状性高乳酸血症。总发生率为20.2例/1000患者-年，女性患者的发生率为27.0例/1000患者-年，男性患者为8.7例/1000患者-年。无患者死亡。9例（20.4%）患者在HAART开始时肥胖。67例患者中有66例接受司他夫定治疗，5例接受去羟肌苷治疗。在56名重新开始HAART治疗的患者中，齐多夫定的核苷类逆转录酶抑制剂累积再暴露量为44.6患者-年，其中41名患者接受了≥ 9个月的治疗，没有复发。南非索韦托的女性有症状的高乳酸血症和乳酸酸中毒的发生率高于其他研究组的患者。在与司他夫定使用相关的病例中，对于核苷类逆转录酶抑制剂替代治疗有限的患者，重新开始HAART治疗时使用齐多夫定似乎是安全有效的。
Background. Lactic acidosis and symptomatic hyperlactatemia may complicate nucleoside reverse-transcriptase inhibitor use. Females may be at increased risk for such complications. Our study evaluated the incidence of lactic acidosis and symptomatic hyperlactatemia by sex, analyzed clinical features, and described the safety of reintroducing highly active antiretroviral therapy ( HAART) with zidovudine replacing stavudine.Methods. A retrospective cohort analysis was performed for 1735 adults ( 63% of whom were female) who initiated HAART from April 2004 through August 2005 in Soweto, South Africa, with follow-up until February 2006. Patients with lactate levels >= 4.5 mmol/L and no potential cause of elevated lactic acidosis other than receipt of HAART were included in the study.Results. A total of 23 patients ( 22 of whom were female) experienced lactic acidosis. The overall incidence was 10.6 cases per 1000 patient-years; the incidence was 16.1 cases per 1000 patient-years in female patients and 1.2 cases per 1000 patient-years in male patients. Seven ( 30.4%) of the patients died. Eight ( 34.8%) of the patients were obese ( body mass index [ calculated as weight in kilograms divided by the square of height in meters], 130) at HAART initiation. Forty-four patients ( 37 of whom were female) had symptomatic hyperlactatemia. The overall incidence was 20.2 cases per 1000 patient-years, with an incidence of 27.0 cases per 1000 patient-years in female patients and 8.7 cases per 1000 patient-years in male patients. None of the patients died. Nine ( 20.4%) of the patients were obese at HAART initiation. Sixty-six of 67 patients were receiving stavudine, and 5 patients were receiving didanosine. Among 56 patients who restarted HAART with zidovudine for a cumulative nucleoside reverse-transcriptase inhibitor reexposure of 44.6 patient-years-including 41 patients who received treatment for >= 9 months-there were no relapses.Conclusion. Women in Soweto, South Africa, have a higher frequency of symptomatic hyperlactatemia and lactic acidosis than has been reported for patients in other study groups. In cases associated with stavudine use, restarting HAART with zidovudine seemed to be safe and effective for patients with limited nucleoside reverse-transcriptase inhibitor alternatives.