Important note: Information in this article was accurate in August 2000. The state of the art may have changed since the publication date.
Another potential complication of anti-HIV therapy, particularly with the use of nukes, is the development of high levels of lactic acid in the blood, a condition called lactic acidosis. Readers should note that lactic acidosis is an unusual occurrence. Indeed, in a recent French study of 800 subjects taking anti-HIV drugs, researchers found that only 1.5% developed lactic acidosis. Signs and symptoms of severe lactic acidosis include the following:
Some researchers think that an earlier, less severe form of lactic acidosis is more common than the severe form. Researchers in San Diego found 33 cases of what they consider mild lactic acidosis in their patients who had used nukes over a two-year period. People who used combinations that included the drug d4T were 14 times more likely to develop mild lactic acidosis than subjects who were not taking d4T. This does not necessarily mean, however, that all people who use d4T are at higher risk of lactic acidosis. Rather, d4T use may merely indicate longer exposure to anti-HIV therapy as it's not uncommon for people to begin therapy with AZT and 3TC and to switch later to d4T and ddI. Treating lactic acidosis
If left untreated, lactic acidosis can be fatal. Researchers in the Netherlands have developed a protocol for treating people experiencing lactic acidosis. First, the patients stop using nukes. Second, they receive intravenous infusions of the following B-complex vitamins:
The patients also receive an infusion of the amino acid L-carnitine at a dose of 1000 mg. All of these nutrients were given to subjects twice daily until lactic acid levels fell to about normal values. The researchers reported treating six subjects using their protocol. All subjects were using d4T and/or hydroxyurea with other nukes. The five subjects who survived took between four and 20 days of therapy before their lactic acid levels returned to nearly normal levels.
1. Gerard Y, Yazdanpanah Y, De la Tribonniere X, et al. Early diagnosis of lactic acidosis in HIV-infected adults receiving antiretrovirals: anion gap measurement. Poster 19.
2.Lonergan JT, Havlir D, Barber E and Mathews WC. Hyperlactatemia associated with clinical manifestations in HIV-infected patients receiving nucleoside analogue combination regimens. Poster 20.
3. Meyer D, Behrens G, Schneider A, et al. Serum-lactate in nucleoside analogue-treated HIV patients correlates with serum-lipids. Poster 52.
4. Brinkman K, Vrouenraets SME, van der Meer J, et al. Treatment of lactic acidosis. Poster 15.
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