Lactic Acidosis and AIDS

TO THE EDITOR:

Chattha and colleagues [1] recently reported seven patients with AIDS who had type B lactic acidosis without other obvious causes. We report an additional case of unexplained lactic acidosis in a 25-year-old, HIV-infected patient with hemophilia. He had been receiving zidovudine for 10 months, had a CD4 count ranging from 230/L to 160/L, and had been symptomatic with ophthalmic herpes zoster 2 years before. He had a hepatitis C infection and mild chronic elevations of his transaminase levels. His symptoms in June 1990 were anorexia, hyperventilation, and weight loss, and he was found to have lactic acidosis with a serum lactate level of 10.4 mmol/L. There was an associated elevation of his aspartate aminotransferase level to 128 U/L (normal range, 8 to 39 U/L), lactate dehydrogenase level to 581 U/L (normal range, 94 to 200 U/L), total bilirubin count to 1.7 mg/dL, and uric acid level to 15 mg/dL without azotemia. An extensive evaluation showed no evidence of hypoxia, hypotension, ischemia, or malignancy. A computed tomographic scan of the abdomen showed diffuse hypodensity of the liver consistent with fatty infiltration. Zidovudine was discontinued, and the acidosis, worsening of liver function tests, and hyperuricemia resolved within 3 months.