Severe lactic acidosis and thiamine administration in an HIV-infected patient on HAART

Abstract

Severe lactic acidosis has been increasingly reported as a potentially fatal complication of HIV treatment. We report on an asymptomatic HIV-infected woman treated with stavudine, lamivudine and indinavir for one year. She was hospitalized because of progressive dispnoea, oedema, cyanosis and severe lactic acidosis. Arterial blood pH was 6.98, bicarbonate 4.4 mmol/l (normal value 22-26), blood lactate: 29.7 mmol/l (normal value <2.2). Hepatic function was normal. She had an impressively rapid response (within a few hours) to empirical treatment with thiamine (100 mg i.v.). No evidence of sepsis or malabsorption were identified and vitamin B1 level was not tested before thiamine infusion. Three months later she was re-started successfully on nelfinavir plus nevirapine. The rapid response to thiamine infusion deserves a careful attention and such an approach should be considered in similar cases as a support treatment of this potentially life-threatening complication of HIV therapy.

Treatment of lactic acidosis: Appropriate confusion

“…101,109 Investigations are ongoing into agents directed at improving mitochondrial function such as riboflavin, thiamine, and L-carnitine. [110][111][112] As with biguanide-associated LA, RRT decisions should be individualized based on metabolic circumstances.…”

Treatment of HAART‐Induced Lactic Acidosis With B Vitamin Supplements

“…[1][2][3]6,9,10 Lactic acid levels of 3.6 to 31.2 mmol/L have been documented, which are extremely high compared with the normal range of 0.6 to 2.1 mmol/L. Plasma levels of riboflavin or thiamin were recorded in only one case, where thiamin was normal (827 pg/mL; normal, 211 to 911) and riboflavin was low (6 nmol/L; normal, 6.2 to 39).…”

“…One describes a 39-year-old woman with progressive dyspnea, edema, and cyanosis. 9 Her HAART regimen included stavudine, lamivudine, and indinavir. She had metabolic acidosis, an elevated aspartate transaminase (AST) level, and a blood lactic acid of 29.7 mmol/L.…”

Lactic acidosis related to nucleoside therapy in HIV-infected patients

“…Although there are no studies proving the benefit of these substances in NRTIinduced lactic acidosis and despite the lack of beneficial effects in one experimental study [56], a few published case reports suggest that they may be useful in some cases [46,[57][58][59][60][61][62][63]. In a review of published cases we found that administration of specific therapy with cofactors was associated with a significantly lower mortality in patients with lactic acidosis [8].…”