Safe Use of NRTIs After Symptomatic Hyperlactatemia

NRTIs are the backbone of potent antiretroviral regimens, and patients who have complications of NRTI therapy are left with few well-studied treatment options. NRTIs, by virtue of their activity against human DNA-polymerase (gamma), a uniquely mitochondrial enzyme, all have the potential to be mitochondrial poisons. NRTIs often cause benign and asymptomatic elevations in serum lactate. Less frequently, patients develop symptomatic hyperlactatemia or even frank lactic acidosis, which is associated with substantial morbidity and mortality in this population. Few reports exist regarding the introduction of less mitochondrially toxic NRTIs in the wake of symptomatic hyperlactatemia and discontinuation of the offending agents. Researchers reviewed charts of patients seen from July 1998 to September 2002 …