Fatal portal hypertension, liver failure, and mitochondrial dysfunction after HIV-1 nucleoside analogue-induced hepatitis and lactic acidaemia

Acute hepatitis with lactic acidosis is a life-threatening but reversible toxic effect on mitochondria of HIV-1 nucleosideanalogue treatment. We report fatal portal hypertension, liver failure, and persistent mitochondrial dysfunction in a man aged 65 years with HIV-1 infection who had recovered fromnucleoside-analogue-induced acute hepatitis and lactic acidaemia more than 18 months previously. We believe that symptomfree patients who receive nucleoside-analogue therapy should have hepatic function constantly monitored, especially those with past or present lactic acidaemia. Acute hepatitis with lactic acidosis is a toxic effect of HIV- 1 nucleoside analogues on mitochondria. 80% of patients with lactate greater than 10 mmol/L die. The longterm outcome of those who survive is unknown, but all reports have shown full recovery.