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Lactic Acidosis and Hepatic Steatosis Associated with Use of Stavudine: Report of Four Cases

Kirk D. Miller, MD; Miriam Cameron, MD; Lauren V. Wood, MD; Marinos C. Dalakas, MD; and Joseph A. Kovacs, MD

1 August 2000 | Volume 133 Issue 3 | Pages 192-196

Background: An association between use of zidovudine and didanosine and a rare but life-threatening syndrome of hepatic steatosis, lactic acidosis, and myopathy has been reported.

Objective: To describe the syndrome of hepatic steatosis, lactic acidosis, and myopathy in four patients taking stavudine.

Design: Case series.

Setting: A community hospital in Washington, D.C., and National Institutes of Health Clinical Center, Bethesda, Maryland.

Patients: Two men and two women with HIV-1 infection who were taking stavudine presented with lactic acidosis and elevated levels of aminotransferases. All patients required intensive care.

Measurements: Levels of lactic acid, alanine aminotransferase, aspartate aminotransferase, amylase, and lipase; computed tomography of the abdomen; liver biopsy (two patients); and muscle biopsy (two patients).

Results: Histologic findings consistent with mitochondrial injury confirmed the diagnosis of hepatic or muscle abnormality.

Conclusion: Because hepatic steatosis may be life-threatening, physicians should consider it as a possible cause of elevated hepatic aminotransferase levels among patients taking stavudine.

Author and Article Information

From Warren Grant Magnuson Clinical Center, National Institute of Allergy and Infectious Diseases Intramural AIDS Program, National Cancer Institute, and National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, Maryland; and Kaiser Permanente Mid-Atlantic and West End Medical Center, Washington, D.C.

Requests for Single Reprints: Kirk D. Miller, MD, Critical Care Medicine Department, Warren Grant Magnuson Clinical Center, National Institutes of Health, Building 10, Room 8C410, Bethesda, MD 20892.

Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.

Current Author Addresses: Dr. Miller: Critical Care Medicine Department, Warren Grant Magnuson Clinical Center, National Institutes of Health, Building 10, Room 8C410, Bethesda, MD 20892.

Dr. Cameron: Division of Infectious Diseases, Kaiser Permanente West End Medical Center, 2100 Pennsylvania Avenue NW, Washington, DC 20037.

Dr. Wood: National Cancer Institute, National Institutes of Health, Building 10, Room 13N240, Bethesda, MD 20892.

Dr. Dalakas: National Institute of Neurological Diseases and Stroke, National Institutes of Health, Building 10, Room 4N248, Bethesda, MD 20892.

Dr. Kovacs: Critical Care Medicine Department, Warren Grant Magnuson Clinical Center, Building 10, Room 7D43, National Institutes of Health, Bethesda, MD 20892.

Author Contributions: Conception and design: K.D. Miller, M. Cameron, J.A. Kovacs.

Analysis and interpretation of the data: K.D. Miller, M.C. Dalakas, J.A. Kovacs.

Drafting of the article: K.D. Miller.

Critical revision of the article for important intellectual content: K.D. Miller, M. Cameron, L.V. Wood, M.C. Dalakas, J.A. Kovacs.

Final approval of the article: M. Cameron, M.C. Dalakas, J.A. Kovacs.

Provision of study materials or patients: K.D. Miller, M. Cameron, L.V. Wood, J.A. Kovacs.

Collection and assembly of data: K.D. Miller, M. Cameron, L.V. Wood, M.C. Dalakas.

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Serious Liver and Metabolism Problems Associated with Use of the Anti-HIV Drug Stavudine

Annals 2000 133: 192. [Full Text]  

Letters
Isoniazid-Induced ß-Hydroxybutyric Acidosis
Peter J. Piliero AND Douglas G. Fish

Annals 2001 134: 799. [Full Text]  

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