• Ernesto Hernández Pérez, Halima Dawood, Ulenta Chetty, Tonya M Esterhuizen, and Maresce Bizaare.
• Infectious Diseases Unit, Department of Medicine, Grey's Hospital, Pietermaritzburg, South Africa.
• Int. J. Infect. Dis. 2008 Sep 1;12(5):553-6.

BackgroundThe use of highly active antiretroviral therapy (HAART) results in multiple side effects that may jeopardize the life of the patient being treated with antiretroviral drugs. In resource-poor settings it is difficult to definitively diagnose lactic acidosis by laboratory measurement of lactate. Point-of-care (POC) devices are helpful in the measurement of lactate levels and have been validated in the intensive care unit setting, but not in a busy outpatient clinic. The objective of this study was to assess the sensitivity and specificity of the Accutrend lactate meter in the diagnosis of hyperlactatemia/lactic acidosis in patients on nucleoside reverse transcriptase inhibitor (NRTI)-containing regimens (stavudine).Design And MethodsThis was a cross-sectional study of 120 patients on HAART (lamivudine, stavudine, efavirenz, or nevirapine) with symptoms of/or recovering from hyperlactatemia/lactic acidosis. Simultaneous testing of the same blood sample was undertaken on the Accutrend handheld lactate analyzer and a reference instrument (Beckman CX7 Synchron machine). A venous lactate level <2.2mmol/l was considered as normal.ResultsThe mean lactate value obtained from the Accutrend meter was 2.89mmol/l and from the reference instrument was 2.78mmol/l. The standard deviation for Accutrend meter was 1.14mmol/l vs.1.42mmol/l for the Beckman instrument. The sensitivity obtained for the Accutrend meter was 95.9% (95% CI 87.7-98.9%) and the specificity 63.8% (95% CI 48.5-76.9%). The positive predictive value was 80.5% (95% CI 70.3-87.9%) and the negative predictive value was 90.9% (95% CI 74.5-97.6%).ConclusionsThe Accutrend lactate meter is an appropriate device for screening patients on HAART with symptoms of hyperlactatemia/lactic acidosis. The use of this device decreases analytic and intervention time, preventing further morbidity and mortality in patients on an NRTI (stavudine)-based regimen.

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