title: Detecting life-threatening lactic acidosis related to nucleoside-analog treatment of human immunodeficiency virus-infected patients, and treatment with L-carnitine.
abstract: OBJECTIVE
  Our first objective was to determine a blood lactate threshold predictive of survival in human immunodeficiency virus patients experiencing lactic acidosis related to nucleoside analogs, and second, to test l-carnitine for the treatment of patients exceeding that threshold.
  
  
  METHODS
  a) Retrospective study using data from personal and published observations to determine the lactate threshold between survivors and nonsurvivors in human immunodeficiency virus patients being treated with nucleoside analogs. b) Prospective multicenter open trial to test l-carnitine treatment of human immunodeficiency virus patients receiving nucleoside analogs.
  
  
  METHODS
  Medical intensive care units of four teaching hospitals and one general hospital.
  
  
  METHODS
  Retrospective analysis of data from 39 human immunodeficiency virus patients (five personal cases and 34 patients from the literature) receiving nucleoside-analog treatment from which lactate values were available. An additional six patients with high lactate values were included as a pilot study testing the use of l-carnitine therapy.
  
  
  RESULTS
  An initial lactate level of 9 mmol/L, which gave good positive and negative predictive values, was determined as a threshold between survivors and nonsurvivors for the patients receiving nucleoside-analog treatment. Six patients with initial lactate levels >10 mmol/L were prospectively treated with l-carnitine; three survived beyond the end of the study.
  
  
  CONCLUSIONS
  The blood lactate levels in human immunodeficiency virus patients receiving nucleoside-analog therapy can predict mortality in these patients. The preliminary data from this pilot study suggest that l-carnitine may be helpful for patients who have nucleoside-analog-related lactic acidosis with blood lactate levels >10 mmol/L. Further studies will be necessary to affirm the therapeutic efficacy of l-carnitine in this setting.
authors.affiliation: Medical Intensive Care Unit, Cochin Hospital, 27 rue du Faubourg Saint-Jacques, F-75679 Paris Cedex 14, France. yann-erick.claessens@caramail.com
authors.forename: Yann-Erick
authors.initials: YE
authors.lastname: Claessens
authors.forename: Alain
authors.initials: A
authors.lastname: Cariou
authors.forename: Mehran
authors.initials: M
authors.lastname: Monchi
authors.forename: Lilia
authors.initials: L
authors.lastname: Soufir
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.forename: Philippe
authors.initials: P
authors.lastname: Rouges
authors.forename: Dany
authors.initials: D
authors.lastname: Goldgran-Toledano
authors.forename: Fabienne
authors.initials: F
authors.lastname: Branche
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dhainaut
mesh_terms: D000140:Acidosis, Lactic / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002331:Carnitine / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D015996:Survival Rate
chemical_list: D000998:Antiviral Agents; D018894:Reverse Transcriptase Inhibitors; D019344:Lactic Acid; D002331:Carnitine