Limitations on antiretroviral therapies as a result of resistance and adverse events have been described in the literature. Lactic acidosis has been reported in patients on nucleoside reverse transcriptase inhibitors on rare occasions. Successful assessment and treatment of lactic acidosis is dependent on the nurse's role in the recognition of this condition. This article provides an overview of the clinical presentation, diagnosis, treatment strategies and nursing management of lactic acidosis in patients with HIV/AIDS.