LETTER
Lactic Acidosis and AIDS
Milford Fulop
15 August 1993 | Volume 119 Issue 4 | Pages 343-345
TO THE EDITOR:
Chattha and colleagues [1] recently described seven patients with the acquired immunodeficiency syndrome (AIDS) who had lactic acidosis without any obvious causes such as circulatory failure or bacteremia. Four patients died of "cardiovascular collapse secondary to metabolic acidosis". The other patients left the hospital, but they too died of AIDS complications. Gopinath and coworkers [2] recently described a patient with AIDS whose lactic acidosis receded as his associated myopathy improved after withdrawal of zidovudine.
Butterworth and colleagues [3] recently described thiamine deficiency in patients with AIDS, which has been proved to cause lactic acidosis in other kinds of patients [4]. To clarify the cause of Wernicke encephalopathy found in some patients with AIDS, Butterworth and associates measured transketolase activity in red cell homogenates [3]. The red cell enzyme activity increased after thiamine pyrophosphate was added to the homogenates, suggesting that thiamine activity was deficient. Eight of the patients were receiving zidovudine.
When lactic acidosis is associated with thiamine deficiency, heart failure is usually present. However, Campbell [4] described 15 Australian aborigine ethanol abusers whose lactic acidosis was cured by administration of thiamine, and many may not have had heart failure.
Thiamine pyrophosphate is a cofactor for pyruvate dehydrogenase (PDH) in the oxidative decarboxylation of pyruvate to acetate, according to the following oversimplified formulation:
Equation OMITTED
Thus, a deficiency of thiamine might cause decreased activity of PDH, hence an accumulation of pyruvate and then of lactate.
1. Chattha G, Arieff AI, Cummings C, Tierney LM Jr. Lactic acidosis complicating the acquired immunodeficiency syndrome. Ann Intern Med. 1993; 118:37-9.
2. Gopinath R, Hutcheon M, Cheemer-Dhadli S, Halperin M. Chronic lactic acidosis in a patient with acquired immunodeficiency syndrome and mitochondrial myopathy: biochemical studies. J Am Soc Nephrol. 1992; 3:1212-9.
3. Butterworth RF, Gaudreau C, Vincelette J, Bourganlt A-M, Lamothe F, Nutini AM. Thiamine deficiency in AIDS. Lancet. 1991; 338:1086.
4. Campbell CH. The severe lactic acidosis of thiamine deficiency. Acute pernicious or fulminating beri-beri. Lancet. 1984; 2:446-9.
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