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Lactic Acidosis
Apr 2, 2001

What are the most common treatments for Lactic Acidosis? Do you simply stop the HIV meds and wait? or are there any other proactive things that can be done? Thanks.

Response from Dr. Henry

Lactic acidosis is a still relatively uncommon but very serious condition. The prevailing view is that lactic acidosis represents a form of mitochondrial toxicity possibly due to the class of drugs known as the nucleoside reverse transcriptase inhibitors. Severe cases can be fatal. The lactic acid level measured in the blood can be raised by exercise prior to the blood draw so there are a number of issues relative to the accurate diagnosis of the condition. Mild cases without symptoms can be observed and often the level of lactic acid will go up and down. More severe cases with symptoms requires prompt attention. It is recommended that the offending drugs be stopped (and if a key part of the whole HIV regimen perhaps stop all medications until resolved). Whether interventions such as vitamin B1, vitamin B2, L-acetyl carnitine, co-Enzyme Q, N-acetyl cysteine (in declining order of support for their benefit) can prevent or treat effectively is not clear. After resolution of the lactic acid elevation upon stopping therapy (can take months in some persons), then restarting a regimen with a substitution for the most drug most likely involved is often successful (for example, switching D4T to AZT or abacavir). Long-term data for large numbers of patients is still lacking. The ACTG and other research groups are working on a number of research studies addressing many of these issues. KH


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