Treatment and prevention of mitochondrial toxicity in HIV-infected patients
- Kees Brinkman, MD, PhD
Kees Brinkman, MD, PhD
- Department of Internal Medicine
- Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
Since the introduction of potent antiretroviral therapy, morbidity and mortality related to HIV infection has improved dramatically. However, chronic administration of antiretroviral medications can lead to various adverse events, including mitochondrial toxicity.
This topic will address the management of mitochondrial toxicity by organ system. The pathogenesis, clinical manifestations, and diagnosis of mitochondrial toxicity is discussed elsewhere. (See "Mitochondrial toxicity of HIV nucleoside reverse transcriptase inhibitors".)
The management of mitochondrial toxicity will depend on the target organ that is involved. Careful consideration of HIV resistance profiles also need to be made when switching from one nucleoside analog to another.
If the clinician determines that there is no suitable alternative, switching to a nucleoside-sparing regimen (eg, a boosted double protease inhibitor combination with either a non-nucleoside analog and/or integrase inhibitor) may be considered. (See "Drug resistance testing in the clinical management of HIV infection".)
Myopathy — HIV-infected patients who develop myopathy while taking zidovudine should be switched to an alternate nucleoside analogue, since this clinical manifestation is related only to this agent. In addition to drug discontinuation, carnitine supplementation may also be considered, although there are no treatment trials supporting this approach.
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- Peripheral neuropathy
- Asymptomatic hyperlactatemia
- Symptomatic hyperlactatemia and lactic acidosis
- SUMMARY AND RECOMMENDATIONS
- Implicated drugs
- Clinical presentation and diagnosis
- - Myopathy
- - Lipoatrophy
- - Asymptomatic hyperlactatemia
- - Symptomatic hyperlactatemia/lactic acidosis