Our first objective was to determine a blood lactate
threshold predictive of survival in human immunodeficiency virus
patients experiencing lactic acidosis
related to nucleoside analogs, and second, to test l-carnitine
for the treatment of patients exceeding that threshold.
a) Retrospective study using data from personal and published observations to determine the lactate
threshold between survivors and nonsurvivors in human immunodeficiency virus
patients being treated with nucleoside analogs. b) Prospective multicenter open trial to test l-carnitine
treatment of human immunodeficiency virus
patients receiving nucleoside analogs.
Medical intensive care units of four teaching hospitals and one general hospital.
Retrospective analysis of data from 39 human immunodeficiency virus
patients (five personal cases and 34 patients from the literature) receiving nucleoside-analog treatment from which lactate
values were available. An additional six patients with high lactate
values were included as a pilot study testing the use of l-carnitine
Measurements and Main Results
An initial lactate
level of 9 mmol/L, which gave good positive and negative predictive values, was determined as a threshold between survivors and nonsurvivors for the patients receiving nucleoside-analog treatment. Six patients with initial lactate
levels >10 mmol/L were prospectively treated with l-carnitine
; three survived beyond the end of the study.
The blood lactate
levels in human immunodeficiency virus
patients receiving nucleoside-analog therapy can predict mortality in these patients. The preliminary data from this pilot study suggest that l-carnitine
may be helpful for patients who have nucleoside-analog-related lactic acidosis
with blood lactate
levels >10 mmol/L. Further studies will be necessary to affirm the therapeutic efficacy of l-carnitine
in this setting.