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Recently introduced, tenofovir disoproxil is the first nucleotide analogue for treating HIV-1 infection. 1 We report a fatal case of lactic acidosis during treatment with tenofovir.
A 45 year old woman presented with vomiting, abdominal pain, and obtundation. She was HIV positive and had been recently treated with a combination of didanosine, stavudine, and nevirapine and had chronic hepatitis C. Because concentrations of liver enzymes had increased eight weeks before admission, nevirapine was stopped; concentrations then returned to initial values. Admitting doctors prescribed enteric coated didanosine (250 mg a day), stavudine (30 mg twice a day), and tenofovir (300 mg a day).
Three days before admission she had developed vomiting, abdominal pain, and then confusion and obtundation. On admission she was...