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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Longitudinal lactate levels from routine point-of-care monitoring in adult Malawian antiretroviral therapy patients: Associations with stavudine toxicities
Transactions of the Royal Society of Tropical Medicine and Hygiene, Volume 107, No. 10, Article trt074, Year 2013
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Description
Introduction: Stavudine is still widely used in under-resourced settings such as Malawi due to its low price. It frequently causes peripheral neuropathy and lipodystrophy and increases the risk of lactic acidosis and other high lactate syndromes. Methods:We studied the association of longitudinal lactate levels, obtained by routine, 3-monthly point-of-care monitoring, with peripheral neuropathy, lipodystrophy and high lactate syndromes in adult Malawians who were in the second year of stavudine containing antiretroviral therapy (ART). Results: Point-of-care lactate measurements were feasible in a busy urban ART clinic. Of 1170 lactate levels collected from 253 patients over the course of one year, 487 (41.8%) were elevated (>2.2mg/dl), 58 (5.0%) were highly elevated (>3.5mg/dl). At least one elevated lactate level occurred in 210 (83.0%) of patients and sustained hyperlactatemia in 65 (26.4%). In random effects analyses lipodystrophy and peripheral neuropathy were associated with higher lactate levels. Only five patients developed high lactate syndromes (one lactic acidosis) of whom no preceding lactate measurements were available because events had started before enrolment. Lactate levels significantly decreased over time and no high lactate syndromes were observed after the 15th month on ART. Conclusion: Lipodystrophy and peripheral neuropathy were associated with higher lactate levels. Lactate levels decreased over time, coinciding with absence of new high lactate syndromes after the 15th month on ART. © The Author 2013. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved.
Authors & Co-Authors
Chagoma, Newton
Malawi, Zomba
University of Malawi
Mallewa, Jane E.
Malawi, Zomba
University of Malawi
Kaunda, Symon
Malawi, Zomba
University of Malawi
Njalale, Yasin
Malawi, Zomba
University of Malawi
Kampira, Elizabeth E.
Malawi, Zomba
University of Malawi
South Africa, Cape Town
Faculty of Health Sciences
Mukaka, Mavuto F.J.
Malawi, Zomba
University of Malawi
Heyderman, Robert Simon
Malawi, Zomba
University of Malawi
van Oosterhout, Joep J.G.
Malawi, Zomba
University of Malawi
Canada, Toronto
Dignitas International
Statistics
Citations: 8
Authors: 8
Affiliations: 3
Identifiers
Doi:
10.1093/trstmh/trt074
ISSN:
00359203
e-ISSN:
18783503
Research Areas
Health System And Policy
Study Design
Cohort Study
Study Locations
Malawi