HI DOCTOR HENRY

I HAVE BEEN ON AZT, 3TC AND SUSTIVA FOR ALOMOST 2 YEARS. VL AND CD4 IN JAN 01 WERE <50 AND 440 RESPECTIVELY.

MY LATEST BLOOD TEST ON JUN 01 WAS FOLLOWINGS: SUGAR 112 BUN 17 CREATININE 0.6 CHOLESTEROL 186 TRIGLYCERIDE 117 HDL-C 49 LDL-C 114 SGOT 24 SGPT 23 LDH 300

LACTATE 5.8 (EXPECTED VALUE IS 0.63-2.44 MMOL/L)

I HAVE BEEN ON MILD STOMACH DISCOMFORT, NAUSEA, AND FATIGUE/FELING WEAK DURING DAYTIME FOR ABOUT ONE MONTH. THESE SYMTOMS ARE NOT GETTING WORSE. I CAN TOLERATE. MY DOCTOR TOLD ME TO REPEAT THE TEST IN A MONTH AND DON'T CHANGE ON DRUGS REGIMEN. BECAUSE THERE MIGHT BE SOME ERRORS ON THE TEST SUCH AS KEEPING CONDITION OF SERUM, WEAKNESS OF MYSELF DURING THE TEST, AND ERROR IN TESTING PROCESS.

WHEN HE LOOKED THROUGH SGOT AND SGPT RESULTS, LACTATE SHOULD NOT BE THIS LEVEL.

HOWEVER I AM VERY WORRIED ABOUT THIS LEVEL WHICH IS OVER 5 MMOL/L, IT CAN LEAD TO LOSS OF ENERGY IN THE CELLS AND CAUSE ORGAN FAILURE AND A HIGH RISK OF DEATH. THIS IS STAGE OF LACTIC ACIDOSIS.

1. WHAT ACTIONS SHOULD I TAKE? 2. WHAT OPTIONS DO I HAVE IF I HAVE COME OFF MEDICATIONS AND SUBSEQUENTLY CHOOSE TO SEEK OUT OTHER MEDICATIONS? 3. HOW WOULD YOU TAKE ACTION IF I AM YOUR PATIENT? 4. IF YOU HAVE ANY IDEAS PLEASE FEEL FREE TO RECOMMEND.

THANK YOU IN ADVANCE FOR YOUR KIND ATTENTION AND HELP.

WITH WARMEST REGARDS WILLIAM

I would recommed that the lactic acid level be carefully repeated (on ice with no exercise in the day before)more quickly such as in the next week. If better then that would be reassuring- if worse then consideration should be made to stop your therapy. Vigorous hydration, use of extra B1, B2, vit C, and perhaps co-enzymne Q/L-carnitine could be considered (no firm data on benefit). That level of increased lactic acid is modest and the symptoms-though worrisome- are non-specific. I would repeat the lactic acid in the next week. KH