Abstract:
Nucleoside reverse transcriptase inhibitors (NRTIs) form the backbone of highly active
antiretroviral therapy (HAART) in resource limited settings. Nucleoside reverse
transcriptase inhibitors are preferred for use due to their low cost, ease of availability in
fixed dose combination, ease of administration, and minimum interaction with food.
However, they have been shown to cause mitochondrial toxicity resulting in drug toxicities
including peripheral neuropathy, lipodystrophy and hyperlactatemia. The objective of this
study was to determine the prevalence of hyperlactatemia and the associated risk factors
among HIV-infected patients on combination antiretroviral therapy attending HIV clinics
at Thika and Ahero District hospitals. This was a descriptive cross-sectional study and
systematic sampling technique was used where all the eligible patients attending the two
HIV clinics during the study period who consented to the study participated. A structured
questionnaire was administered before collection of a blood sample to measure the lactate level. The overall prevalence of hyperlactatemia (lactate >2.5 mmol/l) in the population of HIV-infected patients on HAART was 41% of whom 3.1% had moderate (lactate >2.5-5 mmol/l) hyperlactatemia. Using multivariable logistic regression models the risk factors for hyperlactatemia was found to be stavudine- containing regimen, female gender, BMI of > 24, a CD4 count of less than 200 at initiation of HAART and being on NRTIs for a period of more than 24 months. The study found that 80% of the patients with
hyperlactatemia were symptomatic. The signs and symptoms included fatigue, muscle
aches, abdominals symptoms, headache, and paraesthesia which were not significant.
Because of the high prevalence of hyperlactatemia and the non-specificity of the clinical
presentation, lactate meters should be availed to aid in accurate diagnosis of
hyperlactatemia.
