Riboflavine and severe lactic acidosis

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Several adverse effects have been associated with nucleoside reverse-transcriptase inhibitors (NRTIs) in people with HIV-1 infection, and decreased mitochondrial energy-generating capacity has been suggested to be the common cause.1 A syndrome characterised by lactic acidosis and hepatic steatosis is a recognised though rare complication of NRTIs, to which some fatalities have been attributed.2 A major breakthrough in the pathophysiology of this NRTI-associated disorder was achieved by Fouty and co-workers3 who found riboflavin deficiency in three patients with lactic acidosis and liver steatosis.