[Outcome of hyperlactatemia and lipodystrophy syndromes in patients infected with human immunodeficiency virus].
HIV-positive persons requiring a highly active antiretroviral therapy containing one or more nucleosidic reverse transcriptase inhibitors associated with or without protease inhibitors are exposed to metabolic side effects among which lipodystrophy and hyperlactemia, defined by blood lactates higher than 2,25 mmol/L. Hyperlactatemia had to be differentiated from lactic acidosis of type B (without hypoxemia, lactates higher than 5 mmol/L and arterial pH lower than 7,3), a rare but potentially fatal complication by multi-visceral failure. The accused INRT induce mitochondrial toxicity by inhibition of DNA gamma polymerase and deterioration of its DNA. Our exploratory study, troop of 282 patients, identified age and stavudine like statistically associated, which has occurred of this metabolic anomaly. The patients having profited of a therapeutic change with the profit from drugs minus hyperlactatogenic presented an obvious clinical and biological improvement; whereas similar switch of therapy occurred for the lipodystrophic patients presented any clinical improvement. Nevertheless, biological parameters (blood lactates, triglycerides, total cholesterol and LDL-cholesterol) were significantly decreased after this therapeutic switch occurred on the lipodystrophic patients. In conclusion, the measurement of the following biological parameters: glycemia, lactatemia, triglycerides, total cholesterol and LDL-cholesterol at patient VIH, in a simple and rigorous pre-analytical and analytical context, appears to us justified in the monitoring of metabolic disorders in treated HIV patients by INRT and/or IP.
Marceau
G
G
Laboratoire de biochimie, Hôtel-Dieu, CHU, 63000 Clermont-Ferrand.
Jacomel
C
C
Ughetto
S
S
Roszyk
L
L
Dastugue
B
B
Laurichesse
H
H
Sapin
V
V
D000140:Acidosis, Lactic / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy; D000328:Adult; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects / Q000379:methods; D002784:Cholesterol / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003937:Diagnosis, Differential; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D054303:HIV Reverse Transcriptase / Q000037:antagonists & inhibitors; D006801:Humans; D007773:Lactates / Q000097:blood; D008060:Lipodystrophy / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects; D012307:Risk Factors; D012720:Severity of Illness Index; D018119:Stavudine / Q000009:adverse effects; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
D008078:Cholesterol, LDL; D007773:Lactates; D018894:Reverse Transcriptase Inhibitors; D014280:Triglycerides; D002784:Cholesterol; D018119:Stavudine; D054303:HIV Reverse Transcriptase