title: Depletion of mitochondrial DNA in liver under antiretroviral therapy with didanosine, stavudine, or zalcitabine.
abstract: The "D drug" HIV reverse-transcriptase inhibitors zalcitabine, didanosine, and stavudine are relatively strong inhibitors of polymerase-gamma compared with the "non-D drugs" zidovudine, lamivudine, and abacavir. D drugs deplete mitochondrial DNA (mtDNA) in cultured hepatocytes. This mtDNA depletion is associated with an increased in vitro production of lactate. To investigate the origin of hyperlactatemia in HIV-infected patients and the effects of antiretroviral therapy on liver mtDNA, we biopsied liver tissue from 94 individuals with chronic hepatitis C virus (HCV) infection. Eighty subjects were coinfected with HIV. Serum lactate was measured at the time of biopsy. Hepatic mtDNA and liver histology were centrally assessed. Liver mtDNA content of HIV-infected patients receiving D drugs at the time of biopsy (n = 34) was decreased by 47% (P<.0001) compared with those without D drugs (n = 35). Aside from a possible association between HCV genotype I status and mtDNA depletion in multivariate analysis, there were no other virologic, immunologic, histologic, demographic or treatment-related variables that could explain the mtDNA depletion. Lactate was above the upper limit of normal in only three patients, all of whom were treated with D drugs. The mtDNA in each of them was lower than in any non-D drug patient and significantly (P =.017) depleted compared with D drug patients with normal lactate. In conclusion, D drug treatment is associated with decreased hepatic mtDNA in HIV-infected patients with chronic HCV infection. Moderate mtDNA depletion in liver does not necessarily lead to hyperlactatemia, but more pronounced decreases in hepatic mtDNA may be an important contributor to lactate elevation.
authors.affiliation: Medizinische Universitätsklinik, Department of Clinical Immunology, Freiburg, Germany. ulrich.walker@klinikum.uni-frieburg.de
authors.forename: Ulrich A
authors.initials: UA
authors.lastname: Walker
authors.forename: Jochen
authors.initials: J
authors.lastname: Bäuerle
authors.forename: Montse
authors.initials: M
authors.lastname: Laguno
authors.forename: Javier
authors.initials: J
authors.lastname: Murillas
authors.forename: Stefan
authors.initials: S
authors.lastname: Mauss
authors.forename: Günther
authors.initials: G
authors.lastname: Schmutz
authors.forename: Bernhard
authors.initials: B
authors.lastname: Setzer
authors.forename: Rosa
authors.initials: R
authors.lastname: Miquel
authors.forename: José M
authors.initials: JM
authors.lastname: Gatell
authors.forename: Josep
authors.initials: J
authors.lastname: Mallolas
mesh_terms: D000140:Acidosis, Lactic / Q000139:chemically induced; D000328:Adult; D003430:Cross-Sectional Studies; D004272:DNA, Mitochondrial / Q000187:drug effects* / Q000378:metabolism; D016049:Didanosine / Q000009:adverse effects*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000378:metabolism; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D008099:Liver / Q000378:metabolism; D008297:Male; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects*; D018119:Stavudine / Q000009:adverse effects*; D016047:Zalcitabine / Q000009:adverse effects*
chemical_list: D004272:DNA, Mitochondrial; D018894:Reverse Transcriptase Inhibitors; D019344:Lactic Acid; D016047:Zalcitabine; D018119:Stavudine; D016049:Didanosine