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Background We describe a 62 year-old HIV-infected male, being treated with didanosine (ddI), stavudine (d4T) and efavirenz, who died with lactacidosis. Co-morbidities were ethanol-induced liver cirrhosis (Child B) and unclear renal insufficiency (GFR 20 ml/min). After 16 months of therapy he developed hyperlactatemia (3.7 mmol/l [normal <2.2]) without acidosis. Two months later after increasing lactic acidosis (pH 6.9, lactate 27 mmol/l) requiring ICU-treatment, including i.v. uridine (20 g/d), he died in multi-organ failure without signs of infection.

Quantitative and qualitative mtDNA-lesions with mitochondrial dysfunction in multiple organs after HAART-associated fatal lactacidosis