Bonnet Fabrice, Balestre Eric, Bernardin Elise, Pellegrin Jean-Luc, Neau Didier, Dabis François
Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André, Bordeaux, France.
Antivir Chem Chemother. 2005;16(1):63-7. doi: 10.1177/095632020501600106.
The objectives of our study were to describe the characteristics of a subset of patients who had been prescribed serum lactate in clinical practice within a large cohort of HIV-infected patients and to determine the factors associated with hyperlactataemia. Hyperlactataemia (> or =2 mmol/l) was found in 219 [29% (95% confidence interval: 25.3-31.7)] of the 768 HIV-infected participants. In multivariate analysis (logistical regression), an increased risk of hyperlactataemia was associated with increasing age, CD4 count <500/mm3, triglycerides >2.2 mmol/L, lipoatrophy and stavudine use. In a second model coding for the NRTI-based drug combinations, only those including stavudine were associated with an increased risk of hyperlactataemia. In a third model including exposure duration to NRTIs, we estimated a 20% increased risk of hyperlactataemia per year of exposure to didanosine or stavudine. The risk of hyperlactataemia could increase over time in patients treated with these drugs and is also closely associated with increased age, decreased CD4 count, lipodystrophy and increased plasma triglycerides. It could be proposed that patients having one or more of these risk factors undergo regular monitoring of plasma lactate and renal function to prevent lactic acidosis.
我们研究的目的是描述在一大群HIV感染患者的临床实践中接受血清乳酸盐检测的一部分患者的特征，并确定与高乳酸血症相关的因素。在768名HIV感染参与者中，有219名（29%，95%置信区间：25.3 - 31.7）出现高乳酸血症（≥2 mmol/L）。在多变量分析（逻辑回归）中，高乳酸血症风险增加与年龄增长、CD4细胞计数<500/mm³、甘油三酯>2.2 mmol/L、脂肪萎缩和使用司他夫定有关。在第二个对基于核苷类逆转录酶抑制剂的药物组合进行编码的模型中，只有那些包含司他夫定的组合与高乳酸血症风险增加有关。在第三个包含核苷类逆转录酶抑制剂暴露持续时间的模型中，我们估计每年暴露于去羟肌苷或司他夫定会使高乳酸血症风险增加20%。接受这些药物治疗的患者高乳酸血症风险可能会随时间增加，并且还与年龄增长、CD4细胞计数降低、脂肪营养不良和血浆甘油三酯升高密切相关。可以建议具有这些风险因素中一个或多个的患者定期监测血浆乳酸和肾功能，以预防乳酸酸中毒。
