PDF(Pubmed)
Abstract：
Lactic acidosis is a rare but serious side effect in individuals receiving nucleoside reverse transcriptase inhibitors. An underweight woman with HIV was admitted to our hospital because of nausea and diffuse myalgia. Her antiretroviral regimen had been changed to tenofovir disoproxil fumarate (TDF)/emtricitabine and darunavir/cobicistat 3 months prior, after which her renal function had gradually declined. After admission, she was diagnosed with lactic acidosis, and a liver biopsy suggested mitochondrial damage. Her plasma tenofovir levels were elevated at the onset of lactic acidosis. We hypothesise that the patient\'s low body weight, combined with the addition of cobicistat, induced renal dysfunction and led to elevated plasma tenofovir concentrations, resulting in mitochondrial damage and lactic acidosis. Careful monitoring of renal function and lactic acidosis is required during use of TDF-containing regimens for underweight HIV patients, particularly when combined with cobicistat.
摘要：
在接受核苷逆转录酶抑制剂的个体中,乳酸性酸中毒是一种罕见但严重的副作用。一名体重过轻的HIV感染者因恶心和弥漫性肌痛入院。3个月前，她的抗逆转录病毒方案已改为富马酸替诺福韦酯（TDF）/恩曲他滨和达瑞那韦/科比司他，之后她的肾功能逐渐下降。入院后,她被诊断为乳酸性酸中毒,肝活检提示线粒体损伤.在乳酸性酸中毒发作时，她的血浆替诺福韦水平升高。我们假设病人体重低,再加上cobicistat,诱导肾功能不全，并导致血浆替诺福韦浓度升高，导致线粒体损伤和乳酸性酸中毒。在使用含TDF的方案治疗体重不足的HIV患者期间，需要仔细监测肾功能和乳酸性酸中毒，特别是与cobicistat结合使用时。
