[Treatment of symptomatic hyperlactatemia and lactic acidosis in HIV+ patients under nucleoside reverse transcriptase inhibitors].
OBJECTIVE
We intended to find out the effectiveness of lactic acidosis therapy for mitochondrial toxicity.


METHODS
HIV-patients receiving nucleoside reverse transcriptase inhibitors (NRTIs), hospitalized with lactic acidosis or symptomatic hyperlactatemia. Venous hyperlactatemia was considered at > 2.2 mmol/l. Treatment consisted of a daily vitamin regime of L-carnitine, thiamine, vitamin B6, hydroxicobalamine, and vitamin C; any glucose intake was discontinued. NRTIs treatment was stopped immediately.


RESULTS
Nine patients on current therapy were identified who had symptomatic hyperlactatemia (n = 4) or lactic acidosis (n = 5) from 1/2001 to 9/2002. All were patients with AIDS, receiving NRTIs with a mean duration of 5 years: ddI (n = 7), d4T (n = 5), AZT(n = 3), 3TC (n = 2), abacavir (n = 1). Most common symptoms were tachypnea, slight fever, abdominal pain, nausea, vomiting and diarrhea. All patients had a favourable prognosis after administration of L-carnitine and vitamin complexes, with discontinuation of NRTIs and glucose intake. Clinical features lasted 7 days. After 15 (5) months of follow up, none had a recurrence of the syndrome.


CONCLUSIONS
The application of this therapy could play a role in the treatment of NRTI - related lactic acidosis.
Pedrol
Enric
E
Departamento de Bioquímica, Fundació Hospital-Asil de Granollers, Observatori Sanitari Dr. Carles Vallbona (OSVA), Granollers, Barcelona, Spain. epedrol@fhag.es
Ribell
Mónica
M
Deig
Elisabet
E
Villà
María del Carmen
Mdel C
Miró
Oscar
O
Garrabou
Glòria
G
Soler
Anna
A
D000140:Acidosis, Lactic / Q000139:chemically induced* / Q000628:therapy*; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002331:Carnitine / Q000627:therapeutic use; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D014815:Vitamins / Q000627:therapeutic use
D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors; D014815:Vitamins; D019344:Lactic Acid; D002331:Carnitine