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Lactic Acidosis and AIDS

TO THE EDITOR: Chattha and associates [1] describe a group of seven human immunodeficiency virus (HIV)-infected patients with lactic acidosis in the absence of hypoxemia or another obvious cause. We suspect that sepsis may be the cause of lactic acidosis in many, if not all, of their patients. Several symptoms described in these patients, including nausea, anorexia, fever, malaise, and tachypnea, are typical of patients with sepsis. The authors stated that they ruled out sepsis by appropriate laboratory tests and diagnostic procedures and by autopsy . Patients with HIV infection frequently have sepsis from occult or unusual infections that elude diagnosis by several diagnostic studies, including invasive biopsies. Blood cultures are positive in only about 50% of patients with clinical sepsis [2]. Normal values for oxygen delivery, consumption, and extraction do not exclude bacterial sepsis [3, 4] but may reflect an oxygen deficit because of increased oxygen demands and may contribute to lactic acid production.