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.
Highlights
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 [1,2,3,4,5,6,7]
Rates of lactic acidosis appear to be higher in southern Africa, 1.1-1.2%, [1,3,8,9,10] when compared with rates previously described elsewhere, 0.1-0.4% [4,9]
Stavudine is still widely used in first-line therapy in developing countries due to its low cost and widespread availability, and programmatic implications of moving towards alternative more costly drugs still need to be sorted out
Summary
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 [1,2,3,4,5,6,7]. Risk factors for the development of moderate to severe symptomatic hyperlactatemia or lactic acidosis include female gender, use of “D” antiretroviral drugs (didanosine (ddI) and/or stavudine (d4T)), having a BMI of greater than 25, decreased CD4+ cell count, the presence of lipodystrophy, and having elevated plasma triglyceride levels [9,12]. 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. The objective of this study was to assess the agreement of the portable (AccutrendTM handheld) lactate analyzer to the conventional laboratory system for obtaining serum lactate
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