Fatal Lactic Acidosis in a Patient with Acquired Immunodeficiency Syndrome Treated with Stavudine, Lamivudine and Indinavir

Abstract

Recently, several class-related adverse events have been recognized with antiretroviral drugs. For nucleoside analogue reverse transcriptase inhibitors (NRTI), lactic acidosis with hepatomegaly and hepatic steatosis have been reported. These appear to occur at a low ferquency, but with a high fatality rate.
We report a case of fatal lactic acidosis in a patient with acquired immunodeficiency syndrome (AIDS) treated with stavudine (d4T), lamivudine (3TC) and indinavir (IDV). A 48-year-old male AIDS patient was admitted with complaints of general fatigue and dyspnea. His medications at presentation included d4T, 3TC and IDV. Physical examination demonstrated icteric sclerae and abdominal tenderness with hepatomegaly. Laboratory data demonstrated a severe metabolic acidosis with an anion gap due to lactate accumulation. Despite intensive treatment, caradiorespiratory arrest accurred and this could not be resuscitated.