Risk factors

Several factors are known or suspected to increase the likelihood that HIV-positive people taking nucleoside reverse transcriptase inhibitors (NRTIs) will develop mitochondrial toxicity:

  • Simultaneous use of multiple mitotoxic agents.
  • Longer use of NRTIs.
  • More advanced HIV disease.
  • Low CD4 cell count.
  • Older age.
  • Obesity or high body mass index.
  • Pre-existing liver impairment.
  • Co-existing medical conditions such as diabetes or hepatitis C.

It is clear that not everyone taking mitotoxic NRTIs develops hyperlactataemia or other conditions attributed to mitochondrial toxicity. However, data from different studies are contradictory regarding who is at risk.

Whilst some studies have found higher rates of mitochondrial damage and associated symptoms in people with lower CD4 cell counts, others have not seen such a relationship.1 2 The same is true for duration of NRTI use.

The United States Food and Drug Administration’s reporting programme found that most of the HIV-positive patients who died due to lactic acidosis were women, some of whom were pregnant. Although a majority of studies suggest that women are more prone to mitochondrial toxicity and its associated conditions, other studies have found higher rates in men, and still others saw no difference.3

References

  1. Lichtenstein KA et al. Significant correlation between low CD4 nadie and the incidence of peripheral neuropathy, pancreatitis, and lactic acidosis. Second International AIDS Society Conference on HIV Pathogenesis and Treatment, Paris, abstract 731, 2003
  2. Bonnet F et al. Risk factors for lactic acidosis in HIV-infected patients treated with nucleoside reversetranscriptase inhibitors: a case-control study. Clin Infect Dis 36: 1324-3128, 2003
  3. Boulassel MR et al. Gender and long-term metabolic toxicities from antiretroviral therapy in HIV-1 infected persons. J Med Virol 78: 1158-1163, 2006
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.