Symptomatic Hyperlactataemia in Adults on Antiretroviral Therapy: A Single-Centre Experience (Original Articles)
The use of nucleoside reverse transcriptase inhibitors (NRTIs) in combination with other antiretroviral drugs in a schedule of antiretroviral therapy (ART) is considered standard-of-care for those living with HIV. (1-3) ART has led to significant decreases in morbidity and mortality, compared with untreated HIV-infected patients. This benefit also extends to those in developing countries. (1,2) Public sector access to ART was initiated in 2004 in South Africa. The recommended first-line regimen comprises two NRTIs in combination with a non-nucleoside reverse transcriptase inhibitor (NNRTI). (4) The combination most frequently used is stavudine, lamivudine and efavirenz (‘regimen 1a’). Nevirapine is recommended instead of efavirenz (owing to teratogenicity concerns) for women of child-bearing potential (‘regimen 1b’). ‘Regimen 2’ includes the combination of didanosine, zidovudine and lopinavir/ritonavir. Criteria for initiation of ART in the public sector for adults and adolescents are CD4 200 cells/[micro]l irrespective of clinical stage, or World Health Organization stage IV illness irrespective of CD4 count.