Nelson: I am taking Zerit+Kaletra+Epivir and am very aafraid of this thing I keep hearing about called mitochondrial toxicity. What are the symptoms and what supplements or things can I take to prevent it? I want to get off Zerit but my doctor does not let me because my viral load is undetectable , so I have to do something to prevent Zerit from destroying my cells. Thanks for all you do.

I wish there was a clear answer to your question. As you probably remember from your biology class in school, the mitocondria are tiny cells within a cell that produce energy as ATP from sugars and fats. It seems that nucleoside analogs (NRTIs) not only inhibit HIV's reverse transcriptas enzyme but also inhibit an enzyme (pol gamma) needed for proper mitochondrial reproduction and function. There are mitochondria in all tissues. This kind of toxicity can affect the muscles (muscle myopathy or weakness and heart muscle weakness- cardiomyopathy), nerves (neuropathy), liver (fatty liver), fat (lipoatrophy), pancreas (pancreatitis), and build up of lactic acid (lactic acidosis) that could be lethal. Test tube (in vitro) studies have demonstrated that ddC, ddI, and d4T are the most potent inhibitors of pol gamma, although the other NARTIs exert some influence as well. To date, researchers have not studied the extent of mitochondrial damage when anti-HIV medications are combined, which is standard practice for most individuals currently on anti-HIV therapy. Moreover, the effect of combining NRTIs with other anti-HIV medications, such as protease inhibitors, is not known.

When someone has lactic acidosis doctors stop all medications, specially NRTIs , to bring the lactic acid levels down. Many also provide a cocktail of antioxidants and aminoacids (Carnitine 3000 mg, Coenzyme Q-10 200-400 mg, Thiamine 100 mg, Roboflavin 100 mg) that are essential for mitochondrial health. But no one to date has shown whether taking these supplements actually prevents mitochondrial toxicity. I personally take these supplements in case. Carnitine also has other benefits like helping to lower lipids in your blood. Coenzyme Q-10 may help some people with fatigue. B vitamins like Thiamine and Riboflavin are essential for about everything that works in our body.

There is an excellent article in thebody.com about this. Go to http://www.thebody.com/step/fall02/mitochondrial.html

I hope researchers spent more time looking at ways to prevent this problem so that all of us who need to take NRTIs can do safely in the long term. I think companies like BMS and Glaxo should lead the way.