Background:  Symptomatic hyperlactitiaemia and lactic acidosis is a complication of nucleosides analogues. This syndrome is noted mostly especially stavudine (d4T). It may present non-specific symptoms of weight loss, nausea, anorexia, and malaise. These signs and symptoms overlap with many other diagnoses. d4T is part of most antiretroviral regimes in the developing world. To confirm the diagnosis, a blood lactate must be performed. At Themba Lethu Clinic in South Africa, the laboratory test is performed on a Gem Premier 3000 blood gas analyzer. This was compared to a point-of-care Accutrend Lactate Analyzer (Roche Diagnostics). Many outlying clinics do not have access to a blood analyzer, thus the need for a point-of-care device is becoming more pressing. There are approximately 350,000 HIV⁺ individuals on antiretrovirals (ARV) in South Africa. The standard first-line regimen includes d4T, lamivudine (3TC), and a NNRTI. The rate of mitochondrial toxicity is estimated to be 19 per 1000 patients.

Methods:  This is a prospective cohort study. A nursing sister was trained in the use of the hand-held device. When a medical officer requested a lactate assay on clinical suspicion, a finger prick specimen and a drop of blood from the laboratory tube were tested using the point-of-care device. Clinical decisions were made on the laboratory test.
Results:  We made 82 comparisons. The mean lactate measurement using the standard laboratory method was 2.53 mM/L (±1.42) compared to 3.14 (1.047) mM/L in the finger-prick method and 2.57 mM/L (±0.92) in the blood-drop method. There was no significant difference between the 2 methods and the standard method using a χ³ test. Lactate results were divided into 3 groups (<2.4, 2.5 to 5.0, and >5.0 mM/L) as these are the strata needed for clinical care. The sensitivity and specificity for the hand-held device in the lower range was 90% and 87.6% (finger-prick method) compared to 86.1% and 72.7% (blood tube method). In the range >2.5 5 mM/L and >5 mM/L, we measured 35 values. The hand-held device has a specificity and sensitivity of 75% and 88.2% for the drop method and specificity and sensitivity of 100% for the tube method. There were no values >5 mM/L on the standard laboratory test that were <5 mM/L on the hand-held device.
Conclusions:  The hand-held device is an adequate screening test for the diagnosis of symptomatic hyperlactatemia.