My lactic acid levels have been at about 5 for past two weeks. I had been on ddi, d4t and Viracept since 1-98 with undetectable viral load, T-cells now at 1000, high cholesterol and triglycerides, facial, limb and buttocks wasting and slight fat pad on neck, but only fat loss, not lean body mass loss, according to two years of bioimpedance analyses. (I'm female.) However, to evade suspected mitochondrial toxicity, we tried adding Viramune six weeks ago, which caused wildly elevated serum ferratin levels and was stopped. I switched to Sustiva, ddi, Viracept two weeks ago after three high lactic acid tests and one normal lactic acid test. My physician attributed my liver problem to Lipitor (which I stopped) + Viramune. Is a switch off ddi and the addition of another protease inhibitor my best treatment option? What doses should I consider of Coenzyme Q-10, riboflavin, and L-carnitine, mentioned in recent articles as anecdotally effective against lactic acidosis? Other suggestions re drug-induced lactic acidosis? If this is too much like a "second opinion," can you name some sources of information for either myself or my physician? Much thanks.

I like the idea of a nonnucleoside such as sustiva or viramune. I also think it was reasonable to come off d4T and monitor your LA levels. I'm not sure that "wildly elevated serum" ferritin levels are necessarily bad by the way. I would not switch off ddi as it is relatively unlikely to be associated with mitochondrial toxicity-related LA.

I don't like to recommend doses in this format. Your doctor should be able to consult with a nutritionist for that info.

Alvan Fisher, M.D.