Validation of A Point-of-Care Lactate Device For Screening At-Risk Adults Receiving Combination Antiretroviral Therapy In Botswana

Abstract

Background Nucleoside reverse-transcriptase inhibitors (NRTIs) are a major component of combination antiretroviral therapy (cART) worldwide but they have been associated with mitochondrial toxicities, with one of the most significant being lactic acidosis. In southern Africa, being female and overweight (BMI > 25) as well as receiving d4T and/or ddI-based cART are risk factors for the development of this potentially life-threatening complication. It is challenging in many resource-limited settings to obtain reliable serum lactate measurements while screening for the presence of lactic acidosis. Point-of-care devices, however, are now available that provide simple, accurate measurements of serum lactate levels at relatively low cost. The objective of this study was to assess the agreement of the portable (Accutrend™ handheld) lactate analyzer to the conventional laboratory system for obtaining serum lactate. Methods Eighty two “at-risk” cART-treated adults were evaluated, having their lactate levels tested in parallel using both modalities. Results The mean (range) lactate level for the portable device was 2.28 (0.9-5.0) compared to 1.96 (0.7-5.4) using the conventional method. There was a strong correlation (p<0.05) between the portable device and the conventional means with a Pearson correlation coefficient of 0.92 [95% CI: 0.88-0.95]. The mean bias was 0.33 [95% CI: -0.39-1.04], with the portable device having slightly higher values. Conclusion The use of a portable lactate device provides an accurate and user-friendly means of screening at-risk patients for the presence of lactic acidosis in resource-limited settings with limited laboratory capacity.

Knowledge and perception on type2 diabetes and hypertension among HIV clients utilizing care and treatment services: a cross sectional study from Mbeya and Dar es Salaam regions in Tanzania

“…Despite improved life expectancy; ART including nucleotide reverse transcriptase Inhibitors (NRTIs) and stavudine based regimens have been reported to increase the risk of raised blood levels of lipid profile (triglycerides, low density lipoprotein cholesterol and total cholesterol) as well as lowering high density lipoprotein [ 17 , 18 ] which are the risk factors for developing T2DM/HTN. Literature shows that prevalence of hypertension among PLHIV was more than twice that of the general population [ 19 ] and that duration on ART is associated with increased cardiovascular risk factors among PLHIV who are on ART [ 20 ]. Further, HIV/AIDS, ART and aging among PLHIV have been consistently reported to be associated with renal related morbidity and mortality [ 21 , 22 ] and type2 diabetes [ 9 – 11 ].…”

Hyperlactatemia and concurrent use of antiretroviral therapy among HIV infected patients in Uganda

“…Further validation studies for the point-of-care lactate device by Moyo et al in Botswana found a strong correlation (Pearson correlation coefficient of 0.92(95% CI 0.88-0.95) between the portable device and conventional methods for blood lactate measurement. 8,9 The use of point-of-care tests for lactic acid levels in an HIV treatment program in rural Haiti greatly assisted clinical decision-making with regard to patients on ART who had symptoms suggestive of lactic acidosis 10 . This instrument uses enzymatic determination and reflectance photometry of lactate in the plasma portion of whole blood by use of a measurement strip.…”

10.4172/jaa.1000036

“…This drug resistance largely fades over time [61,62]. Although nucleoside reverse-transcriptase inhibitors (NRTIs) remain a critical component of current HIV-1 treatment regimens, they have been associated with functional and structural mitochondrial abnormalities, leading to several adverse events, such as pancreatitis, peripheral neuropathy, and lactic acidosis [63].…”