Acidose lactique sévère chez les patients infectés par le VIH traités par inhibiteurs nucléosidiques de la reverse transcriptase : 9 cas

Bonnet, Fabrice; Bonarek, M.; Abridj, A; Mercié, P.; Dupon, M.; Gemain, M.-C.; Malvy, Denis; Bernard, N.; Pellegrin, Jean‐Luc; Morlat, Philippe; Beylot, J

doi:10.1016/s0248-8663(02)00702-6

Cited by 13 publications

(4 citation statements)

References 13 publications

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“…Although ART in the ICU setting presents distinct challenges related to drug delivery, doses, drug interactions, and antiretroviral-associated toxic effects (23–28), the findings of our study demonstrate benefit of this therapy in HIV-infected critically ill patients at 6 months after ICU admission. Furthermore, we identified several risk factors associated with in-ICU and 6-month mortality in developing countries.…”

Section: Discussionmentioning

confidence: 63%

Benefit of antiretroviral therapy on survival of human immunodeficiency virus-infected patients admitted to an intensive care unit

Croda

Neves

et al. 2009

Critical Care Medicine

102

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Objective To evaluate the impact of antiretroviral therapy (ART) and the prognostic factors for in-intensive care unit (ICU) and 6-month mortality in human immunodeficiency virus (HIV)-infected patients. Design A retrospective cohort study was conducted in patients admitted to the ICU from 1996 through 2006. The follow-up period extended for 6 months after ICU admission. Setting The ICU of a tertiary-care teaching hospital at the Universidade de São Paulo, Brazil. Participants A total of 278 HIV-infected patients admitted to the ICU were selected. We excluded ICU readmissions (37), ICU admissions who stayed less than 24 hours (44), and patients with unavailable medical charts (36). Outcome Measure In-ICU and 6-month mortality. Main Results Multivariate logistic regression analysis and Cox proportional hazards models demonstrated that the variables associated with in-ICU and 6-month mortality were sepsis as the cause of admission (odds ratio [OR] = 3.16 [95% confidence interval [CI] 1.65– 6.06]); hazards ratio [HR] = 1.37 [95% CI 1.01–1.88]), an Acute Physiology and Chronic Health Evaluation II score > 19 [OR = 2.81 (95% CI 1.57–5.04); HR = 2.18 (95% CI 1.62–2.94)], mechanical ventilation during the first 24 hours [OR = 3.92 (95% CI 2.20–6.96); HR = 2.25 (95% CI 1.65–3.07)], and year of ICU admission [OR = 0.90 (95% CI 0.81– 0.99); HR = 0.92 [95% CI 0.87– 0.97)]. CD4 T-cell count <50 cells/mm3 was only associated with ICU mortality [OR = 2.10 (95% CI 1.17– 3.76)]. The use of ART in the ICU was negatively predictive of 6-month mortality in the Cox model [HR = 0.50 (95% CI 0.35– 0.71)], especially if this therapy was introduced during the first 4 days of admission to the ICU [HR = 0.58 (95% CI 0.41– 0.83)]. Regarding HIV-infected patients admitted to ICU without using ART, those who have started this treatment during ICU stay presented a better prognosis when time and potential confounding factors were adjusted for [HR 0.55 (95% CI 0.31– 0.98)]. Conclusions The ICU outcome of HIV-infected patients seems to be dependent not only on acute illness severity, but also on the administration of antiretroviral treatment. (Crit Care Med 2009; 37: 000–000)

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Section: Discussionmentioning

confidence: 63%

Benefit of antiretroviral therapy on survival of human immunodeficiency virus-infected patients admitted to an intensive care unit

Croda

Neves

et al. 2009

Critical Care Medicine

102

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“…As the patient’s sepsis resolved, lactic acid showed a downtrend but remained persistently elevated due to inappropriate Biktarvy use. Multiple cases of lactic acidosis from antiretroviral therapy have been documented, with some cases being fatal [ 8 ]. While agents like zidovudine, lamivudine, didanosine, and other agents not found in Biktarvy are more strongly associated with this adverse event, all NRTIs have the potential to cause mitochondrial inhibition [ 8 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Multiple cases of lactic acidosis from antiretroviral therapy have been documented, with some cases being fatal [ 8 ]. While agents like zidovudine, lamivudine, didanosine, and other agents not found in Biktarvy are more strongly associated with this adverse event, all NRTIs have the potential to cause mitochondrial inhibition [ 8 , 9 ]. There have been similar cases where inappropriate dosing or overdose of NRTI therapy has led to severe lactic acidosis, especially in the setting of renal impairment and concomitant use of other nephrotoxic agents [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Severe Lactic Acidosis Due to Inappropriate Use of Biktarvy in a Patient With AIDS

Strike,

Velez Oquendo,

Chowdry

et al. 2024

Cureus

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Bictegravir-emtricitabine-tenofovir alafenamide is an approved medication for the treatment of acquired immunodeficiency syndrome (AIDS). This medication, also called Biktarvy, includes an integrase strand inhibitor combined with nucleoside reverse transcriptase inhibitors (NRTIs) to prevent viral DNA synthesis and lead to improvements in disease progression and mortality in patients with AIDS. A rare but previously documented adverse effect of NRTIs present in Biktarvy is lactic acidosis. NRTIs can cause lactic acidosis through mitochondrial impairment, as mitochondria depend on DNA polymerase gamma for replication. This enzyme is very similar to HIV’s reverse transcriptase. Inhibition of mitochondrial production results in increased anaerobic metabolism and lactic acid production. We present a case where an inappropriately high dosage of Biktarvy in a patient with septic shock led to persistent lactic acidosis despite clinical improvement. After a thorough medication review, Biktarvy was temporarily held, and the lactic acidosis resolved. This clinical presentation stresses the importance of maintaining wide differentials for lactic acidosis and thorough medication reconciliation.

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“…Analysing the drugs in use, the combination of d4T plus ddI is associated with the highest risk [8,[35][36][37]. In a retrospective study performed in France, nine cases of severe lactic acidosis were identified [38]. The incidence was 0.9/1000 patient-years of exposure to nucleoside analogues.…”

Section: Hyperlactataemia and Lactic Acidosismentioning

confidence: 99%

The Role of Hepatitis C Virus (HCV) in Mitochondrial Dna Damage in HIV/HCV-Coinfected Individuals

Mendoza¹,

Soriano²

2005

Antiviral Therapy

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Oxidative stress accompanying hepatitis C virus (HCV) infection seems to result in mitochondrial (mt) dysfunction. In HIV/HCV-coinfected individuals, HCV-related mt damage could be further enhanced and clinical manifestations of mt damage may appear, particularly following exposure to some antiretroviral drugs. Furthermore, when HCV medications are used together with certain antiretrovirals, the risk of developing mt adverse events may be particularly frequent, such as development of pancreatitis when ribavirin and didanosine are coadministered. The management of HIV/HCV-coinfected individuals needs to consider the high risk of mitochondria-associated toxicities in this population, which may significantly influence treatment decisions and therapeutic modalities.

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Acidose lactique sévère chez les patients infectés par le VIH traités par inhibiteurs nucléosidiques de la reverse transcriptase : 9 cas

Cited by 13 publications

References 13 publications

Benefit of antiretroviral therapy on survival of human immunodeficiency virus-infected patients admitted to an intensive care unit

Benefit of antiretroviral therapy on survival of human immunodeficiency virus-infected patients admitted to an intensive care unit

Severe Lactic Acidosis Due to Inappropriate Use of Biktarvy in a Patient With AIDS

The Role of Hepatitis C Virus (HCV) in Mitochondrial Dna Damage in HIV/HCV-Coinfected Individuals

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