Background of study: Highly active antiretroviral therapy (HAART) reduces AIDS mortality, however long-term metabolic toxicities are now being discovered. We experienced a number of patients with the following complaint triad: lethargy, fatigue and slow mentation.
Objective: 1) To evaluate patients experiencing lethargy, fatigue and slow mentation to look for any association with chemical or metabolic imbalance. 2) To look for any association with HAART regimen.
Design: Prospective, case series of patients complaining of above symptoms. Patients received the following tests: CBC, chemistries, including ammonia, lactic acid, TSH, liver scans/ultrasounds and hepatitis panels. All medications were recorded.
Results: Six patients were identifed. Pt. Demographics: 83% male,17% female, 66% white, 17% black, 17% hispanic, 67% HIV, 33% AIDS. Mean age 43 (27-55) years. Clinically significantly elevated ammonia levels were the one common finding among patients The mean baseline ammonia level was 77.5 (55-129) umol/L.. Other tests were within normal limits including liver function tests. Liver scans/ultrasounds were performed in 3 patients. Hepatomegaly was found in 2 patients and fatty liver in one. The remaining patients are being evaluated. The only common ARV found was treatment with 3TC for a mean 32 months (13-50). Fifty percent of patients received lactulose therapy for 2-4 weeks resulting in a mean ammonia level decrease of 58% and
clinically significant improvement in lethargy, fatigue and mentation.
Conclusion: Patients on HAART complaining of the triad of lethargy, fatigue and slow mentation, demonstrated clinically significantly elevated ammonia levels with otherwise normal metabolic studies. Ammonia levels and clinical symptoms improved following treatment with lactulose. Further study is required to evaluate elevated ammonia levels in HIV-infected patients receiving HAART.
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