Lactic acidosis, risk factors and predictive laboratory markers: A nested case control study in South Africa
Background: The incidence of antiretroviral therapy (ART)-induced lactic acidosis and its associated mortality may be reduced by appropriate dosing, risk stratification and early detection. Objectives: To describe the epidemiology of lactic acidosis, define the risk factors and identify predictive...
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AOSIS
2014-02-01
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| Series: | South African Family Practice |
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| Online Access: | https://safpj.co.za/index.php/safpj/article/view/3712 |
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| author | C.A. Luke M.Y.S. Moosa T.M. Esterhuizen S.E. Knight S. Saman A. Ross |
| author_facet | C.A. Luke M.Y.S. Moosa T.M. Esterhuizen S.E. Knight S. Saman A. Ross |
| author_sort | C.A. Luke |
| collection | DOAJ |
| description | Background: The incidence of antiretroviral therapy (ART)-induced lactic acidosis and its associated mortality may be reduced by appropriate dosing, risk stratification and early detection.
Objectives: To describe the epidemiology of lactic acidosis, define the risk factors and identify predictive laboratory markers in the context of the roll-out of ART in South Africa.
Design: A nested case control study. Risk factor analysis was adjusted for the established risk factors of weight and gender.
Setting and subjects: Persons commenced on stavudine-containing therapy between 2004 and 2007 at Port Shepstone Hospital in KwaZulu-Natal were included. Persons with a body weight above 60 kg received Stavudine 40 mg twice daily, and those with a body weight below 60 kg, 30 mg twice daily.
Outcome measures: Assessed risk factors included weight, gender, age, alanine transaminase (ALT), urea, creatinine, albumin, cholesterol, triglyceride (TG) levels, CD4 counts and viral loads.
Results: Lactic acidosis occurred in 79 (17 per 1 000 person-years) of 1 762 people living with HIV on ART. Significant factors were being female [adjusted odds ratio (AOR) of 5.4] and increased body weight (adjusted OR of 1.1 per kg). The risk of lactic acidosis increased 6.6, 6.9 and 95 times (adjusted ORs) as weight increased from a baseline weight of 60 kg to 60-69 kg, 70-79 kg or 80 kg, respectively. Six months into therapy, predictors of developing lactic acidosis were an ALT 50 IU/l (adjusted OR of 11.1) and a higher TG (adjusted OR of 8.8 per mmol/l). No associations were found with regard to age, CD4 count, viral load, and creatinine or albumin levels.
Conclusion: Obese females are at greatest risk of lactic acidosis, with an exponential increase in risk above 80 kg. The 30-mg dose may be preferable, given that a sharp increase in risk occurred at 60 kg, was most likely dose related, and that 30 mg has been shown to provide adequate virological suppression. Additional risk factors for lactic acidosis include a high ALT and TG levels at treatment. |
| format | Article |
| id | doaj-art-963564fa6ce347748c9f50cb8a003bf7 |
| institution | DOAJ |
| issn | 2078-6190 2078-6204 |
| language | English |
| publishDate | 2014-02-01 |
| publisher | AOSIS |
| record_format | Article |
| series | South African Family Practice |
| spelling | doaj-art-963564fa6ce347748c9f50cb8a003bf72025-08-20T03:06:54ZengAOSISSouth African Family Practice2078-61902078-62042014-02-0156110.4102/safp.v56i1.37124870Lactic acidosis, risk factors and predictive laboratory markers: A nested case control study in South AfricaC.A. Luke0M.Y.S. Moosa1T.M. Esterhuizen2S.E. Knight3S. Saman4A. Ross5Discipline of Family Medicine, University of KwaZulu-Department of Infectious Disease, University of KwaZulu-NatalDivision of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-NatalDiscipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-NatalPort Shepstone HospitalDiscipline of Family Medicine, University of KwaZulu-NatalBackground: The incidence of antiretroviral therapy (ART)-induced lactic acidosis and its associated mortality may be reduced by appropriate dosing, risk stratification and early detection. Objectives: To describe the epidemiology of lactic acidosis, define the risk factors and identify predictive laboratory markers in the context of the roll-out of ART in South Africa. Design: A nested case control study. Risk factor analysis was adjusted for the established risk factors of weight and gender. Setting and subjects: Persons commenced on stavudine-containing therapy between 2004 and 2007 at Port Shepstone Hospital in KwaZulu-Natal were included. Persons with a body weight above 60 kg received Stavudine 40 mg twice daily, and those with a body weight below 60 kg, 30 mg twice daily. Outcome measures: Assessed risk factors included weight, gender, age, alanine transaminase (ALT), urea, creatinine, albumin, cholesterol, triglyceride (TG) levels, CD4 counts and viral loads. Results: Lactic acidosis occurred in 79 (17 per 1 000 person-years) of 1 762 people living with HIV on ART. Significant factors were being female [adjusted odds ratio (AOR) of 5.4] and increased body weight (adjusted OR of 1.1 per kg). The risk of lactic acidosis increased 6.6, 6.9 and 95 times (adjusted ORs) as weight increased from a baseline weight of 60 kg to 60-69 kg, 70-79 kg or 80 kg, respectively. Six months into therapy, predictors of developing lactic acidosis were an ALT 50 IU/l (adjusted OR of 11.1) and a higher TG (adjusted OR of 8.8 per mmol/l). No associations were found with regard to age, CD4 count, viral load, and creatinine or albumin levels. Conclusion: Obese females are at greatest risk of lactic acidosis, with an exponential increase in risk above 80 kg. The 30-mg dose may be preferable, given that a sharp increase in risk occurred at 60 kg, was most likely dose related, and that 30 mg has been shown to provide adequate virological suppression. Additional risk factors for lactic acidosis include a high ALT and TG levels at treatment.https://safpj.co.za/index.php/safpj/article/view/3712lactic acidosisstavudineantiretroviraltoxicityhuman immunodeficiency virus |
| spellingShingle | C.A. Luke M.Y.S. Moosa T.M. Esterhuizen S.E. Knight S. Saman A. Ross Lactic acidosis, risk factors and predictive laboratory markers: A nested case control study in South Africa South African Family Practice lactic acidosis stavudine antiretroviral toxicity human immunodeficiency virus |
| title | Lactic acidosis, risk factors and predictive laboratory markers: A nested case control study in South Africa |
| title_full | Lactic acidosis, risk factors and predictive laboratory markers: A nested case control study in South Africa |
| title_fullStr | Lactic acidosis, risk factors and predictive laboratory markers: A nested case control study in South Africa |
| title_full_unstemmed | Lactic acidosis, risk factors and predictive laboratory markers: A nested case control study in South Africa |
| title_short | Lactic acidosis, risk factors and predictive laboratory markers: A nested case control study in South Africa |
| title_sort | lactic acidosis risk factors and predictive laboratory markers a nested case control study in south africa |
| topic | lactic acidosis stavudine antiretroviral toxicity human immunodeficiency virus |
| url | https://safpj.co.za/index.php/safpj/article/view/3712 |
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