by Anne Monroe
June 2004
Lactic Acidosis is a buildup of lactic acid in the blood. It is a rare but serious side effect of the nucleoside reverse transcriptase inhibitor (NRTI) class of HIV drugs, especially Zerit (d4T), and Videx (ddI).
NRTIs stop HIV from reproducing inside CD4 cells. This keeps viral load down and boosts CD4 cells. But NRTIs can also have negative side effects. One such side effect is mitochondrial toxicity.
Mitochondria are inside human cells and produce energy by breaking down sugars and fat. At the same time, lactic acid is made as a waste product. Normally, the body breaks down lactic acid and gets rid of it.
With mitochondrial toxicity, the mitochondria are damaged and lactic acid is not broken down. Lactic acid levels get too high and cause the symptoms of lactic acidosis.
It’s important to know the symptoms so you can get in touch with your doctor if you experience any of them. Early identification of lactic acidosis is very important. The condition can cause death if it’s not caught early and treated.
The symptoms of lactic acidosis include:
- Nausea
- Vomiting
- Abdominal pain/swelling
- Weight loss
- Muscle weakness
- Trouble breathing
- Heart rhythm changes
You may need to stop taking your HIV drugs while your doctor does a medical work-up. Permanent discontinuation of certain drugs may be necessary in confirmed cases of lactic acidosis.
Certain factors put people at higher risk for lactic acidosis, including:
- Treatment with ddI and/or d4T (when used together, the risk is even higher)
- The combination of Hydroxyurea or Ribavirin (for hepatitis C) plus ddI
- ddI and/or d4T use during pregnancy
- Obesity
- Female gender
- Poor liver function
There is a lab test to look for elevated lactate (lactic acid) in the blood.
- A normal lactate value is less than two
- If your value is more than two but less than five, and you have none of the symptoms of lactic acidosis, your doctor would probably continue your meds
- If your value is more than five, and you have symptoms of lactic acidosis, your doctor would probably stop your medications as this is getting into the danger zone
- If your value is more than 10, and you have symptoms, you have outright lactic acidosis. You doctor would stop your meds and you would be admitted to the hospital for treatment. Lactic acidosis at this stage is a medical emergency
Many patients on HIV treatment have elevated lactate. It usually doesn’t cause any problems. For that reason, it is not recommended that lactate levels be checked regularly. However, if you experience any of the symptoms of lactic acidosis described above, tell your doctor.
Because lactic acidosis is so rare, there have not been a lot of opportunities to study treatment. Doctors have used a variety of vitamins, including thiamine, riboflavin (vitamin B2), carnitine, and coenzyme Q, to treat lactic acidosis. These vitamins help the body process energy better.
Because there is a connection between liver problems and lactic acidosis, have your doctor check your liver function while you are taking NRTIs, especially if you have a history of heavy alcohol use or a liver problem.
Although lactic acidosis is life-threatening, it is very rare. The point of learning about lactic acidosis is not to scare you. It’s to help you be aware of what’s going on in your body. That way, if you recognize any symptoms of lactic acidosis, you can tell your doctor and get checked out.
Stay on top of your health and you can help your doctor help you!
| 1 | |
Bonnet, F., et. al. (2003). Risk factors for lactic acidosis in HIV-infected patients treated with nucleoside reverse-transcriptase inhibitors: A case-control study. Clinical Infectious Diseases 36(10). 1324-1328: Retrieved June 2004 from http://www.journals.uchicago.edu/CID/journal/issues/v36n10/30301/30301.html |
| 2 | |
Carr, A. (2003). Lactic academia in infection with human immunodeficiency virus. Clinical Infectious Diseases 35(supplement 2). S96-S100: Retrieved June 2004 from http://www.journals.uchicago.edu/CID/journal/issues/v36nS2/20751/20751.html |
| 3 | |
Chow, D., et. al. (2003). Metabolic complications of HIV therapy. HIV InSite Knowledge Base Chapter: Retrieved June 2004 from |
| 4 | |
HIVandHepatitis.com. (2003). Lactic acidemia in HIV infection. Retrieved June 2004 from http://www.hivandhepatitis.com/recent/metabolic/lactic_acidosis/042303j.html |
| 5 | |
Project Inform. (2001). Mitochondrial damage and lactic acidosis: Retrieved June 2004 from http://www.projectinform.org/fs/mito.html |
