Lactic acidosis and hyperlactatemia associated with lamivudine accumulation and sepsis in a kidney transplant recipient—a case report and review of the literature
| Autor: | Aurélien Emmanuel Martinez, Martin Siegemund, Emmanuelle Landmann, Catia Marzolini, Anne Leuppi-Taegtmeyer, Michael Dickenmann, Manuel Battegay, Nadine Cueni, Alexa Hollinger |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Anti-HIV Agents HIV Infections Case Report Gastroenterology Sepsis chemistry.chemical_compound Abacavir Virology Internal medicine medicine Humans Hyperlactatemia Pharmacology (medical) Kidney transplantation Aged business.industry Lactic acidosis Metabolic acidosis Lamivudine RC581-607 medicine.disease Kidney Transplantation AIDS chemistry NRTI Dolutegravir Molecular Medicine Acidosis Lactic Immunologic diseases. Allergy business ART medicine.drug |
| Zdroj: | AIDS Research and Therapy, Vol 18, Iss 1, Pp 1-5 (2021) AIDS Research and Therapy |
| ISSN: | 1742-6405 |
| Popis: | Background We report a case of sudden, lethal metabolic acidosis in a 70-year-old man on long-term nucleoside reverse transcriptase inhibitor (NRTI) -based antiretroviral therapy (ART) who had developed atypical necrotizing fasciitis 1 month after kidney transplantation. Case presentation The HIV infection of the patient was treated for the last four months with an integrase strand inhibitor (dolutegravir 50 mg/d) plus a NRTI backbone including lamivudine (150 mg/d) and abacavir (600 mg/d). In this renal transplant patient we hypothesize that the co-existence of sepsis, renal failure and an accumulation of lamivudine led to the development of fatal metabolic acidosis and hyperlactatemia. Although lamivudine is only rarely associated with hyperlactatemia, there is evidence that overdose may be a risk factor for developing it. In our patient the lamivudine concentration two days after stopping and during hemodiafiltration was more than 50 times higher than therapeutic target trough concentrations. Likely reasons for this were renal impairment and concurrent treatment with trimethoprim, known to inhibit the renal elimination of lamivudine. Conclusions NRTIs could trigger the development of hyperlactatemia in septic patients. The use of NRTI sparing regimens might be considered in the presence of this critical condition. |
| Databáze: | OpenAIRE |
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