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Lactic Acidosis and AIDS
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TO THE EDITOR:
Chattha and colleagues [1] suggested that the lactic acidosis was related to mitochondrial dysfunction induced by zidovudine therapy. No information was given about cumulative doses of zidovudine nor were attempts made to document zidovudine mitochondrial myopathy by clinical testing, evaluation of serum creatine kinase level, electromyogram, or muscle biopsy.
We report a patient with zidovudine-associated myopathy who developed severe lactic acidosis. A 68-year-old man with AIDS was treated with zidovudine for 14 months (total dose, 200 g), after which myalgias and proximal weakness developed. Muscle biopsy specimens showed numerous, ragged red fibers, myofilamentous abnormalities, and cytochrome c oxidase deficiency affecting 26% of the muscle fibers, typical of zidovudine-associated myopathy [2], mixed with marked inflammatory endomysial infiltrates of CD8+ cells and sarcolemmal expression of HLA-ABC antigen consistent with HIV-associated myopathy [3]. He had a threefold increase in his serum creatine kinase level, with an 11% MB fraction, and hyperlactatemia (7.5 mmol/L, normal < 1.6). Blood pressure was 150/80 mm Hg. Sepsis was not diagnosed. Progressive dyspnea developed; the arterial lactate level was 11 mmol/L, the arterial pH was 7.20, PO 2 was 115 mm Hg, and PCO 2 was 13 mm Hg. Lactatemia increased up to 27 mmol/L, arterial pH decreased to 6.85, and the patient died 2 weeks after diagnosis of high blood lactate.
Mitochondrial dysfunction related to zidovudine was assessed in this patient by histochemistry in skeletal muscle and may have accounted for myocardial damage [4] associated with an elevated serum creatine kinase-MB fraction. Hyperlactatemia in this patient was probably related to mitochondrial dysfunction, as was reported in a patient with lactic acidosis and zidovudine myopathy [5]. That only a minority of patients with zidovudine myopathy develop marked lactic acidosis suggests that host-associated or environmental factors are important.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
