2nd International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 13-15 September 2000, Toronto, Canada

TREATMENT OF LACTIC ACIDOSIS

Antiviral Therapy 2000; 5(Suppl. 5):32 (abstract no. P15)

K Brinkman¹, SME Vrouenraets¹, J vd Meer², R Peerenboom³, R Kaufmann⁴, HM Weigel¹ and PHJ Frissen^1
1OLVG-Amsterdam; ²AMC-Amsterdam; ³AZVU-Amsterdam; and ⁴Leyenburg Ziekenhuis-Den Haag, The Netherlands

INTRODUCTION: Lactic acidosis is the most serious manifestation of mitochondrial toxicity, with a reported fatality rate >50%. Beneficial treatment with riboflavin or L-carnitine has been suggested in case reports. A protocol for treatment was developed.

PROTOCOL: In cases of symptomatic lactic acidosis: stop NRTI treatment immediately, start treatment with vitamin B complex forte (per 2 ml ampul: 50 mg thiamine, 10 mg riboflavine, 100 mg nicotinamide, 10 mg pyridoxine, 10 mg dexpanthenol) 4 ml twice daily and L-carnitine 1000 mg twice daily, both intravenously until lactate levels fall below 3 mmol/l.

RESULTS: From November 1999, six successive patients were treated according to this protocol (NRTI backbones: three stavudine plus didanosine plus hypoxyurea, one stavudine plus lamivudine, one stavudine plus didanosine, one didanosine plus hypoxyurea plus lamivudine plus abacavir). All patients recovered. One patient deliberately stopped all treatment after 6 days and died spontaneously 3 days later. Five patients survived. Normalization to lactate <3 mmol/l lasted from 4 to >20 days. Two patients restarted therapy with abacavir plus lamivudine-containing therapy: in one rapid hyperlactatemia reappeared, one patient showed a good response without recurrent hyperlactataemia so far.

CONCLUSIONS: Surviving lactic acidosis can be achieved with a high state of alertness, immediate interruption of NRTIs and a protocol as suggested above.

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