Risk factors for lactic acidosis in HIV-infected patients treated with nucleoside reverse-transcriptase inhibitors:: A case-control study

被引:47
作者
Bonnet, F
Bonarek, M
Morlat, P
Mercié, P
Dupon, M
Gemain, MC
Malvy, D
Bernard, N
Pellegrin, JL
Beylot, J
机构
[1] Hop St Andre, Serv Med Interne & Maladies Infectieuses, Fed Med Interne Maladies Infectieuses & Pathol Tr, F-33075 Bordeaux, France
[2] Hop Pellegrin, Dept Med Interne & Maladies Infectieuses, F-33076 Bordeaux, France
[3] Hop Haut Leveque, Serv Med Interne & Maladies Infectieuses, Pessac, France
[4] Ctr Hosp Cote Basque, Serv Med Interne, Bayonne, France
关键词
D O I
10.1086/374601
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
A case-control study was undertaken to determine risk factors for lactic acidosis in human immunodeficiancy virus-infected patients treated with nucleoside reverse-transcriptase inhibitors (NRTIs). From May 1996 to June 2000, 9 patients with lactic acidosis (defined as a plasma lactic acid level of 15 mM and plasma pH of <7.38) were identified. Control patients were randomly selected from among a large cohort of patients who initiated a dual NRTI regimen in 1996 or after. Two factors were associated with an increased risk of lactic acidosis: first, a creatinine clearance of <70 mL/min before lactic acidosis (OR, 15.8 [range, 3.0-86.5], P < 10(-4)), and, second, a low nadir CD4(+) T lymphocyte count before the inception of NRTI therapy (OR, 8.4 [range, 1.2-∞], P = .03). The total cumulative exposure to NRTIs was not associated with an increased risk of lactic acidosis, nor was the cumulative exposure to any of the 4 NRTIs studied. According to these results, monitoring of creatinine clearance, especially in patients with a low nadir CD4(+) T lymphocyte count, could lead to modifications in antiretroviral therapy in order to diminish the risk of occurrence of lactic acidosis.
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页码:1324 / 1328
页数:5
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