Document Detail

Asymptomatic hyperlactataemia: predictive value, natural history and correlates.
MedLine Citation:
PMID:  15134182     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The significance of asymptomatic hyperlactataemia is unknown. METHODS: We measured serial lactate levels in a group of HIV-infected subjects. Objectives were to identify covariates associated with hyperlactataemia, and to explore the natural history of hyperlactataemia. RESULTS: Overall, 1487 lactate measurements were performed on 396 subjects; 299 subjects had serial lactate testing, with a median of four performed per patient (range: 2-16). At study entry, lactate was >2.4 mmol/l in 6% of subjects and >3.6 mmol/l in 1%. A multiple logistic regression analysis revealed that cholesterol and current stavudine were the only predictors of hyperlactataemia. Lactate levels were highly reproducible both for short-term (within 3 months) and long-term (>1 year) follow-up. During the study period, 16 subjects were identified with sustained hyperlactataemia; 12/16 remained asymptomatic after a median of 210 days (30-585), and four developed symptoms suggestive of lactic acidosis syndrome. In three of the four, asymptomatic hyperlactataemia had preceded the onset of symptoms by 18-122 days. A longitudinal model showed a rapid rise of lactate levels from 0 to 12 months on nucleoside reverse transcriptase inhibitor (NRTI) and then stabilization. Lactate levels did not correlate with baseline or on-study development of lipoatrophy. CONCLUSIONS: Even when optimal methods of collection are used, asymptomatic hyperlactataemia does exist and could be sustained in a subset of NRTI-treated subjects for as long as 585 days. A subset of these subjects became symptomatic, after as long as 122 days of asymptomatic hyperlactataemia. Asymptomatic hyperlactataemia is not predictive of lipoatrophy.
Grace A McComsey; Linda Yau
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Antiviral therapy     Volume:  9     ISSN:  1359-6535     ISO Abbreviation:  Antivir. Ther. (Lond.)     Publication Date:  2004 Apr 
Date Detail:
Created Date:  2004-05-11     Completed Date:  2004-06-28     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9815705     Medline TA:  Antivir Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  205-12     Citation Subset:  IM    
Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
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MeSH Terms
Acidosis, Lactic / chemically induced,  diagnosis*,  physiopathology*
Anti-HIV Agents / adverse effects*,  therapeutic use
Cholesterol / blood
Drug Therapy, Combination
HIV Infections / complications*,  drug therapy
Lactates / blood,  metabolism*
Longitudinal Studies
Middle Aged
Predictive Value of Tests
Prospective Studies
Reverse Transcriptase Inhibitors / adverse effects*,  therapeutic use
Stavudine / adverse effects,  therapeutic use
Reg. No./Substance:
0/Anti-HIV Agents; 0/Lactates; 0/Reverse Transcriptase Inhibitors; 3056-17-5/Stavudine; 57-88-5/Cholesterol

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