[Lactic acidosis in HIV-patients--diagnosis and treatment].
Lactic acidosis is a life-threatening complication of antiretroviral therapy with an incidence of about 1% per year. Its clinical onset is often abrupt, with uncharacteristic muscular, cardiac or hepatic symptoms. Lactic acidosis is caused by nucleoside analogue reverse transcriptase inhibitors (mainly didanosine, stavudine and zalcitabine), which are relatively strong inhibitors of gamma polymerase, the enzyme responsible for the replication of mitochondrial DNA. Zidovudine is also a mitochondrial toxin, but its toxicity probably reflects several mechanisms unrelated to mtDNA-depletion. When lactic acidosis is diagnosed, nucleoside analogues and other mitochondrial toxins, such as valproic acid and acetylsalicylic acid, must be discontinued immediately. Uridine should be supplemented, a cocktail consisting of vitamins, L-carnitine and coenzyme Q10, may be given.
Walker
U A
UA
Abt. Rheumatologie und Klin. Immunologie, Med. Universitätsklinik Freiburg. ulrich.walker@klinikum.uni-freiburg.de
D000136:Acid-Base Equilibrium / Q000187:drug effects; D000140:Acidosis, Lactic / Q000139:chemically induced* / Q000175:diagnosis; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000074002:DNA Polymerase gamma; D004261:DNA Replication / Q000187:drug effects; D004272:DNA, Mitochondrial / Q000187:drug effects; D004259:DNA-Directed DNA Polymerase; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D019384:Nucleic Acid Synthesis Inhibitors; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use
D019380:Anti-HIV Agents; D004272:DNA, Mitochondrial; D019384:Nucleic Acid Synthesis Inhibitors; D018894:Reverse Transcriptase Inhibitors; D019344:Lactic Acid; D000074002:DNA Polymerase gamma; D004259:DNA-Directed DNA Polymerase; C413027:POLG protein, human
Laktatazidose bei HIV-Patienten erkennen und behandeln. Hier ist rasches Handeln angesagt.