Validation of a point-of-care lactate device for screening at-risk adults receiving combination antiretroviral therapy in Botswana

Sikhulile Moyo, Hermann Bussmann, Phibeon Mangwendeza, Priti Dusara, Tendani Gaolathe, Madisa Mine, Rosemary Musonda, Erik van Widenfelt, Vladimir Novitsky, Joseph Makhema, Richard Marlink, Max Essex, C. William Wester

Publication Date: 12/01/2011

Background: Nucleoside reverse-transcriptase inhibitors (NRTIs) are a major component of combination antiretroviral therapy (cART) worldwide but they have been associated with mitochondrial toxicities, with one of the most significant being lactic acidosis. In southern Africa, being female and overweight (BMI > 25) as well as receiving d4T and/or ddI-based cART are risk factors for the development of this potentially life-threatening complication. It is challenging in many resource-limited settings to obtain reliable serum lactate measurements while screening for the presence of lactic acidosis. Point-of-care devices, however, are now available that provide simple, accurate measurements of serum lactate levels at relatively low cost. The objective of this study was to assess the agreement of the portable (Accutrend TM handheld) lactate analyzer to the conventional laboratory system for obtaining serum lactate. Methods: Eighty two “at-risk” cART-treated adults were evaluated, having their lactate levels tested in parallel using both modalities. Results: The mean (range) lactate level for the portable device was 2.28 (0.9-5.0) compared to 1.96 (0.7- 5.4) using the conventional method. There was a strong correlation (p<0.05) between the portable device and the conventional means with a Pearson correlation coefficient of 0.92 [95% CI: 0.88-0.95]. The mean bias was 0.33 [95% CI: -0.39-1.04], with the portable device having slightly higher values. Conclusion: The use of a portable lactate device provides an accurate and user-friendly means of screening at-risk patients for the presence of lactic acidosis in resource-limited settings with limited laboratory capacity.