Severe lactic acidosis and thiamine administration in an HIV-infected patient on HAART

Severe lactic acidosis has been increasingly reported as a potentially fata l complication of HIV treatment. We report on an asymptomatic HIV-infected woman treated with stavudine, lamivudine and indinavir for one year. She wa s hospitalized because of progressive dispnoea, oedema, cyanosis and severe lactic acidosis. Arterial blood pH was 6.98, bicarbonate 4.4 mmol/l (norma l value 22-26), blood lactate: 29.7 mmol/l (normal value <2.2). Hepatic fun ction was normal. She had an impressively rapid response (within a few hour s) to empirical treatment with thiamine (100 mg i.v.). No evidence of sepsi s or malabsorption were identified and vitamin B1 level was not tested befo re thiamine infusion. Three months later she was re-started successfully on nelfinavir plus nevirapine. The rapid response to thiamine infusion deserv es a careful attention and such an approach should be considered in similar cases as a support treatment of this potentially life-threatening complica tion of HIV therapy.