Investigation of the effect of Stalanev (Stavudine, Lamivudine and Nevirapine) treatment on plasma lactate levels in adults attending Beatrice Road and Wilkins Infectious Diseases Hospital Opportunistic Infections Clinics in Harare, Zimbabwe.

Abstract

Main objective: To evaluate the effect of Stalanev (Stavudine, Lamivudine and Nevirapine) treatment on plasma lactate levels in adults attending Beatrice Road Infectious Diseases Hospital and Wilkins Infectious Diseases Hospital Opportunistic Infections Clinics in Harare.

Design: Prospective cohort study carried out between January and May 2011.

Setting: Beatrice Road and Wilkins Infectious Diseases Hospital Opportunistic Infections Clinics in Harare, Zimbabwe.

Participants: A convenience sample of 180 ART naive HIV infected adults aged 20-68 years who were about to be initiated on STALANEV were recruited.

Results: The mean plasma lactate at baseline was 1.57 mmol/L (SD 0.43). After two months on STALANEV, 25 participants (13.9%) had hyperlactatemia and the mean plasma lactate level was 1.99 mmol/L (SD 0.49). At four months follow up, 98 participants (54%) had hyperlactatemia and the mean plasma lactate level was 2.65 mmol/l (SD 0.55). Mean plasma lactate levels increased significantly from baseline to 2 months follow up and from 2 months follow up to 4 months follow up (p < 0.001). None of the participants developed lactic acidosis (plasma lactate > 3.5) after two months of follow up but 14 (7.8%) developed mild lactic acidosis and three (1.7%) had moderate lactic acidosis after four months on STALANEV.

Conclusions: Our findings are in agreement with those of other studies that reported that treatment with STALANEV leads to hyperlactatemia thereby posing a risk for the development of lactic acidosis in patients. In the absence of alternative regimens, we recommend routine monitoring of plasma lactate levels on all patients on STALANEV in Zimbabwe.