Symptomatic hyperlactataemia and lactic acidosis in the era of highly active antiretroviral therapy.
Tygerberg Hospital and Stellenbosch University.South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde (Impact Factor: 1.71). 01/2006; 95(12):929-30.
Article: Metabolic acidosis in AIDS patients.[Show abstract] [Hide abstract]
ABSTRACT: Metabolic acidosis (MA) is a frequent and serious complication in HIV-infected patients. The aim of the study is to compare patients with and without MA associated with HIV. Patients were retrospectively studied involving all HIV-infected patients with blood gas analysis performed during hospital stay admitted to a single hospital between April 2004 and July 2006. Statistical analysis was performed using SPSS 10.0 for Windows. Included in the study were 159 HIV patients, 72 cases (45.3%) with MA and 87 cases (54.7%) without. The comparison of both groups showed a mean arterial pH of 7.24 +/- 0.08 vs. 7.44 +/- 0.05, HCO(3) 12 +/- 5.7 vs. 21 +/- 5.1 mEq/L, serum urea 81 +/- 68 mg/dL vs. 39 +/- 46 mg/dL and serum creatinine 2.7 +/- 2.6 mg/dL vs. 1.2 +/- 1.9 mg/dL in MA-HIV and non-MA-HIV, respectively (p <0.05). Antiretroviral therapy (ART) was being administered to 38 subjects (52.8%) in MA-HIV group and 45 (51.7%) in non-MA-HIV group (p = 0.57). There was no association between the use of ART and MA. Mortality was higher in patients with acidosis (52.7 vs. 17.2%, p <0.0001). In the present study, MA was associated with acute kidney injury and increased mortality. There was no association between the use of ART and MA.Archives of medical research 03/2009; 40(2):109-13. · 1.88 Impact Factor
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ABSTRACT: INTRODUCTION:: Stavudine is a commonly used drug in paediatric antiretroviral treatment (ART) regimens. Due to toxicity concerns, however, the drug abacavir has replaced stavudine in first-line paediatric regimens in many countries. We describe the frequency of stavudine toxicity in children receiving ART at a treatment clinic in Soweto, South Africa. METHODS:: Data on patient characteristics and outcomes of ART were collected from a cohort of 2222 HIV-infected children initiating ART between 2004 and 2008 when stavudine-containing regimens were routinely recommended. At several time-points after treatment initiation, we estimate the proportion of children where an attending clinician discontinued stavudine due to lipodystrophy, pancreatitis, lactic acidosis or peripheral neuropathy. Factors associated with stavudine-related toxicities were identified. RESULTS:: At ART initiation, most children had advanced disease. The majority initiated an efavirenz/lamivudine/stavudine regimen (n = 1422), and 76% of children remained on their initial ART regimen after a median 19.9 months of ART. Replacement of stavudine due to drug toxicity occurred at a rate of 28.8 per 1000 child years on treatment (95% confidence interval = 23.6-35.2). Rates of toxicity increased with treatment duration (in their first year of ART stavudine was replaced in 0.5% of children, but after three years stavudine had been changed to abacavir in 12.6% of children). Toxicity was commoner in older children and in girls. Lipodystrophy accounted for 87 of 96 toxic events. CONCLUSIONS:: Stavudine-associated toxicity resulting in single-drug substitution was uncommon in this cohort, though its frequency increased steadily with ART duration, especially with lipodystrophy. Where drug options are limited, stavudine remains a relatively safe and effective option for children.AIDS (London, England) 11/2012; · 6.56 Impact Factor
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ABSTRACT: Le VIH est l’une des principales causes de mortalité dans les environnements caractérisés par des ressources limitées, et les urgences médicales associées au VIH sont des motifs courants de consultation dans les services d’urgence dans les zones à forte prévalence. Le VIH attaque le système immunitaire, rendant les individus infectés plus susceptibles de contracter de graves infections de multiples organes, tels que les voies respiratoires, les structures oculaires et le système nerveux central. Les personnes séropositives souffrent également de types de maladies cardiaques uniques, de troubles gastro-intestinaux et de troubles hématologiques et oncologiques. La thérapie antirétrovirale est elle-même associée à nombre d’effets secondaires, dont beaucoup peuvent s’avérer mortels. Le diagnostic et la prise en charge des patients séropositifs nécessitent une bonne connaissance de la pathologie de la maladie et des complications mortelles qui y sont associées. La deuxième partie de cet article se penche sur les complications hématologiques/oncologiques, oculaires, gastro-intestinales et associées au traitement.African Journal of Emergency Medicine. 12/2013; 3(4):197–202.
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