When and why

A lactate test can identify oxygen deficiency or other conditions that cause excess production of lactate, the ionic (electrically-charged) form of lactic acid. In HIV infection, lactic acidosis is rare, but hyperlactataemia is common. It can be caused by mitochondrial toxicity or an inherited metabolic disorder.

Most nucleoside analogue drugs used in HIV treatment can cause elevated lactate levels. Once the condition is identified, it can usually be treated by switching to another drug in the NRtI class.

Symptoms of excess lactate include shortness of breath, fatigue, nausea, and excess sweating.

Sometimes fasting is required, but not always. The test is usually done using a blood sample drawn from a vein in the arm. The test can also be performed on a sample drawn from an artery or from cerebrospinal fluid (CSF). A CSF sample for lactate might be taken if someone had symptoms of meningitis such as severe headache, fever, delirium, and loss of consciousness or as an add-on to another test requiring that method. Point of care devices are available at relatively low cost and have improved diagnosis and treatment of excess lactate in Haiti and South Africa.1 2

How it will help

Test results are used to detect and quantify oxygen shortage (hypoxia) from lactic acidosis. If there is an excess of lactate, a change of ARV regimen will probably be made. Lactate levels are also used to monitor heart conditions and shock.


  1. Ivers LC, Mukherjee JS Point of care testing for antiretroviral therapy-related lactic acidosis in resource-poor settings. AIDS 20 (5): 779-780, 2006
  2. Mathee S et al. Point of care lactate testing is an effective measure in supporting the WHO first-line regimen in settings with a high incidence of stavudine-related toxicity. Sixteenth International AIDS Conference, Toronto, Abstract MOPE0085, 2006
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.