Thiamine for the treatment of nucleoside analogue-induced severe lactic acidosis

Nucleoside analogue-induced lactic acidosis is an often fatal condition in patients with HIV. There is only one report of successful treatment with ri boflavin. We describe a 30-year-old female with AIDS and nucleoside analogu e-induced lactic acidosis that exacerbated shortly after introducing total parenteral nutrition and reversed within hours after the addition of thiami ne. Successful treatment of nucleoside analogue-induced lactic acidosis wit h a high dose of thiamine supports the hypothesis that vitamin deficiency i s an important cofactor in the development of this rare and unpredictable c ondition in patients with HIV. We suggest that high dose B-vitamins should be given to any patient presenting with lactic acidosis under nucleoside an alogue treatment.