Lactic Acidosis

LD had been on his HIV drug regimen for some time. Aside from the typical nausea and occasional diarrhea, he had tolerated the course of therapy just fine, and it seemed to be working. But slowly, LD began to experience symptoms that gave him cause for concern. Muscle pain and weakness, worsening nausea and vomiting, and abdominal pain became constant companions. Soon he began to experience the pain, burning and tingling of peripheral neuropathy and worsening weakness. He attributed the symptoms to his medicines and called his doctor to request a change. He was surprised to find out a few days later that he was suffering from a potentially serious HIV related problem...Lactic Acidosis.

Medication Side Effects and Solutions

What is Lactic Acidosis?

Each of the trillions of cells in our body uses energy by processing glucose and fats. This processing occurs in the power plant of our cells called the mitochondria. In normal, healthy cells, the mitochondria produce the energy we use each and every second of everyday. In this energy production, a byproduct called lactic acid is produced. Typically, the lactic acid is processed by the cell and eliminated from the body. But in instances where the mitochondria have been damaged, lactic acid builds up in our cells and blood stream resulting in Lactic Acidosis.

How Are Mitochondria Damaged?

How do the mitochondria get damaged in the first place? While the exact mechanism is not clear, mutations or damage to the mitochondria in HIV infected people have been linked to the use of one class of HIV medication known as nucleoside analogues. This class includes the drugs:

• Epivir (lamivudine, 3TC)
• AZT (zidovudine, Retrovir)
• Abacavir (Ziagen)
• Zerit (d4T)
• Hivid (ddC)
• Videx (ddI)
• Trizivir (Ziagen+AZT+Epivir)
• Emtriva (emtricitabine)
• Epzicom (Epivir+Ziagen)
• Truvada (Viread+Emtriva)

Mitochondria need a certain enzyme to to reproduce. These drugs interfere with that enzyme, blocking the mitochondria's ability to reproduce, leaving the body with fewer functioning mitochondria. In addition, these drugs are thought to interfere with the normal functioning of the mitochondria, making lactic acidosis more likely.

Signs and Symptoms of Lactic Acidosis

Recognizing lactic acidosis early is the key to a good recovery. The symptoms most commonly associated with lactic acidosis include:

• elevated lactic acid levels in the blood (diagnosed with a blood test)
• nausea / vomiting
• abdominal pain
• difficulty breathing
• severe weakening of muscles in the legs and arms.

Blood Test Fact Sheets

What Can Be Done

The best way to reduce your risk of this serious problem is to know your own body. Learn all you can about the medicines you are taking and be alert for any signs or symptoms that may signal an elevated lactic acid level or the onset of lactic acidosis. For now, the only way to arrest this problem if it does develop is to stop nucleoside analogue therapy all together. Some researchers are looking at enzyme replacement as a possible answer to this problem. In addition, scientists are racing to develop new nucleoside analogue drugs that are less likely to cause mitochondrial damage. But for now, the key to being healthy is to recognize signs and symptoms of lactic acidosis and notify your doctor immediately if they do occur.

Is it Time to Call Your Doctor?