3rd International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 23-26 October 2001, Athens, Greece

[¹³C]-Octanoicacid breath test for measurement of hepatic β-oxidation in HIV patients receiving nucleoside-analogue reverse transcriptase inhibitors

Antiviral Therapy 2001; 6(Suppl. 4):26 (abstract no. 34)

GMN Behrens¹, A Leodolter², B Schmedes¹, M Stoll¹ and RE Schmidt^1
1Hannover Medical School, Hannover; and ²University of Magdeburg, Germany

BACKGROUND: Severe lactic acidosis induced by nucleoside analogue reverse transcriptase inhibitors (NRTI) is a rare but one of the most fearful adverse events during antiretroviral therapy. Asymptomatic hyperlactatemia is more frequently observed during antiretroviral therapy and its clinical management is still unresolved since lactate measurement failed to provide prognostic information.

OBJECTIVES: Prospective pilot study in HIV-infected patients.

METHODS: Twenty patients underwent a [¹³C]- octanoic acid breath and assessment of various metabolic parameters including venous gas analysis and lactate measurement. HIV patients receiving therapy including either stavudine or zidovudine were compared to therapy-naïve patients.

RESULTS: Five out of 20 patients presented with abnormal test results with delayed occurrence of ¹³CO₂ determined as t_½ <200 min. These patients had either severe lipoatrophy, mild unspecific gastrointestinal symptoms, a history of severe lactic acidosis, or manifest lactic acidosis shortly following the study. Abnormal breath test results correlated with the duration of NRTI treatment and abnormal hepatic parameters. Impaired gastic emptying in these patients, also able to lead to abnormal breath test results, was excluded by scintigraphy.

CONCLUSIONS: The [¹³C]-octanoic acid breath test seems to be a reliable tool to assess impaired hepatic β-oxidation in NRTI-treated patients. Further studies to determine the prognostic value and the impact of treatment interventions of symptomatic and asymptomatic hyperlacatemia are warranted.

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