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Usai T, Tshalibe R. S, Nyamunda B. C / International Journal of Engineering Research and
Applications (IJERA) ISSN: 2248-9622 www.ijera.com
Vol. 3, Issue 4, Jul-Aug 2013, pp.1768-1771
Prevalence of Lactic Acidosis Syndrome in People Taking
Antiretroviral Drugs at a Local Health Centre
Usai T1, Tshalibe R. S.1, Nyamunda B. C.2
1(Department of Food Science and Nutrition, Midlands State University, P Bag 9055, Gweru, Zimbabwe 2(Department of Chemical Technology, Midlands State University, P Bag 9055, Gweru, Zimbabwe ABSTRACT
This study examines the types of
bicarbonate concentrations [2,3]. Under normal antiretrovirus (ARV) drugs and the foods taken
circumstances, lactate should not be present in blood by people who are HIV positive. The study aims to
at concentrations greater than 1.5 meq/L [4,5]. establish whether the drugs and food consumed
It was established that lactic acidosis is commonly are associated with the development of lactic
found in people with diseases involving circulatory acidosis. A sample of 20 people drawn from a
collapse and in HIV people taking specific population supplied with ARV drugs at a local
antiretroviral drugs [6]. ARV drug combinations are polyclinic
given to HIV positive people to prolong life. interviews were the main tools used in the study to
However some ARV drug combinations produce gather information on the types of ARVs, their
toxic acids or damage cells/leucocytes [7]. Stavudine, side effects and the dietary regimen for people
who were prone to lactic acidosis. The results
nevirapine or ritonavir and established that the ARV drug combinations of
nevirapine exhibit such toxic effects. People taking lamivudine,
stavudine
nevirapine
these drug combinations may develop liver problems ritonavir, stavudine and nevirapine were taken by
associated with lactic acidosis [2]. Studies have the sample population, and that part of this
shown that women with CD4 count higher than 250 population experienced symptoms associated with
cells per mm3are at greater risk of developing lactic lactic acidosis. The results also established that the
acidosis [7]. Lactic acidosis can also be attributed to dietary regimen for those who experienced the
symptoms of lactic acidosis was carbohydrate
Foods that are acidic like some fruits and dense, included acid forming foods, such as
fermented foods may increase the blood acidity level fermented foods and was limited on vegetables
in HIV positive people increasing the chances of and citrus fruits. The research findings indicate a
developing lactic acidosis [8,9]. Consumption of knowledge gap among HIV positive people on
sugary foods tends to increase glucose levels in the food choices and recommended dietary regimens.
body [10]. Under conditions of hypoxia, excess The researcher recommends that nutritionists and
glucose is converted to lactic acid which might dieticians produce and distribute pamphlets,
accumulate resulting in lactic acidosis. Causes of magazines,
lactic acidosis can be medical, related to immunology recommended dietary regimen for HIV positive
or dietary [11]. Doyle [12] reported that lactic people and that income generating projects be set
acidosis can be caused by organs (liver kidney, liver) up to ensure adequacy of food supply in their
disorders, obesity, stress, fear and malnutrition. homes. Based on the findings the researcher
According to Hopewood [13], anti diabetic drugs also proposes a dietary regimen that may be suitable
cause lactic acidosis. for HIV positive people.
This study seeks to evaluate whether the prevalence of lactic acidosis in HIV positive people Keywords: ARV drugs, dietary regimen, HIV
getting treatment from a local clinic was associated positive, lactic acidosis, regimen. with ARV drug consumed and/or dietary regimen. Most studies on lactic acidosis were done on diabetic and cancer patients [14-16]. To the best of our Lactic acidosis is a disease characterized by knowledge no such studies have been reported on unexplained weight loss and elevated blood lactate people affected by HIV. The investigation seeks levels [1]. This disease is a result of either over further to come out with recommendations on how to production or under utilization of lactate. Lactic acid reduce or eliminate factors that induce lactic acidosis is produced as a byproduct in cells during process of on HIV patients. glycolysis. Once produced, the lactic acid is excreted by the liver and kidneys. Its accumulation lowers the METHODOLOGY
blood pH leading to the development of lactic Two instruments were used to collect acidosis, characterized by elevated lactate levels usually greater than 5 meq/ L and decreased interviews. Purposive sampling was used to find out 1768 P a g e

Usai T, Tshalibe R. S, Nyamunda B. C / International Journal of Engineering Research and
Applications (IJERA) ISSN: 2248-9622 www.ijera.com
Vol. 3, Issue 4, Jul-Aug 2013, pp.1768-1771
the most common types of ARV drugs used and types ARVs Symptoms
of foods taken. Questionnaires consisting of both ARV drugs cause adverse effects after closed and open ended questions were used. The taking them. Of the 20 HIV positive respondents 60% study was conducted with 20 people who were HIV experienced symptoms of either feeling very weak positive and receiving ARVs at a local health centre and tired, weakness in arms and legs and nausea, (Mkoba 13 Polyclinic Gweru). The survey focused shortness in breathe and nausea while 40% of the on obtaining data on respondents' demography, types respondents did not experience any symptom. Not all
of ARV drug combinations and their side effects and the respondents experience symptoms of lactic dietary regimen. acidosis. According to Devlin [2], people taking ARV drug combination with stavudine may not develop problems associated with lactic acidosis. Fig. Drugs taken by respondents
2 shows the frequency of the symptoms that were Table 1 shows the drug combination taken experienced by 12 of the respondents after taking by the HIV patients. Antiretroviral drug combination ARV medication. Some respondents indicated more of lamivudine, stavudine and nevirapine was the most than one symptom. Nine respondents felt weak and common drug administered (80% respondents). Only tired, 6 experienced weakness in arms and legs and 1 5% of the respondents were taking ritonavir, respondent experienced nausea. lamivudine and nevirapine due to development of lactic acidosis. The other 15% were not yet on ARVs drugs but taking cotirmoxazole prophylaxis because they were still under CD4 count monitoring. Table 1: Drugs taken by HIV respondents
Drug combination lamivudine, stavudine, ritonavir, lamivudine, cotirmoxazole prophylaxis Fig. 1 shows that most (80%) of the respondents take drugs after a meal. Only 3 (15%) people took drugs on empty stomach and 5% after eating a non fat snack. ARV tablets containing stavudine could be tolerated on an empty stomach but those taking arms and legs weak and tired ritonavir could not since it causes nausea. All the respondents did not take high energy meals since Symptoms
they are potentially lactic acidosis inducing. Figure 2: Frequency at which symptoms were
experienced after taking ARVs. Dietary regimen
Meals taken per day by the respondents
Most of the respondents had at least three meals per day. 2 out of 20 of the respondents had two meals per day, 9 had three meals and the remainder had more than three meals a day. Table 2 shows the nutritional value as an index of biological value of the foods taken at breakfast, lunch and supper. At breakfast 35% of the respondents (n=20) had a balanced diet with high biological value (HBV) proteins from animal sources such as eggs and beef. 25% had low biological value (LBV) proteins from vegetable sources such as cowpeas and sugar beans. 40% of the respondents did not have a balanced diet which carbohydrates. Tea with sugar was commonly taken at breakfast. Sugary foods are not recommended to HIV positive people who are prone to lactic acidosis. Figure 1: Meals consumed by HIV respondents
Eating sugary foods tends to increase glucose levels before taking ARVs tablets. in the body resulting in conversion of glucose to 1769 P a g e

Usai T, Tshalibe R. S, Nyamunda B. C / International Journal of Engineering Research and
Applications (IJERA) ISSN: 2248-9622 www.ijera.com
Vol. 3, Issue 4, Jul-Aug 2013, pp.1768-1771
lactic acid under conditions of limited oxygen supply diarrhoea. 45% of respondents consumed acid forming foods such as maheu, yoghurt, and tea with At lunch 50% of respondents did not have a sugar while 55% avoided such foods. Acid forming balanced diet (protein deficient and carbohydrate foods aggravate the development of lactic acidosis. dense). 50% had a balanced diet of which 90% of this Table 2: Nutritional value of meals
population had HBV protein (beef, roasted termites Nutritional value of a meal and fish) and 10% LBV proteins (beans). The negative economic effects were clearly shown at breakfast and lunch since most of the respondents were concerned about filling up the stomach without considering nutrients required by the body. During supper 90% of the respondents had a Weight of respondents
balanced diet with HBV protein and this can be 80% of the respondents weighed between 52 attributed to supper being considered as the most and 62 kg. This could be attributed to the fact that important meal of the day. 5% had LBV protein and once people are on ARV drugs, it is recommended the other 5% did not have a balanced diet during that they should not be overweight to avoid drug side effects. Another factor could be due harsh economic Green leafy vegetables were the common source of minerals, vitamins and roughage.16 out of the 20 respondents included vegetables in their diet, 2 Knowledge of respondents on diet
included fruits in their servings and 2 respondents 5% of the respondents had limited lacked both fruits and vegetables in their diets. Fruits knowledge of suitable diet to follow. Although are recommended in HIV people since they provide micronutrients that are needed for metabolism of fats, appropriate diets to follow, some did not have carbohydrates and proteins. Eating fruits that contain adequate knowledge on nutrition in terms of zinc such as avocado, pears and paw-paws improves amounts, alleges and intolerance of certain foods by white cell counts and antibody production. Zinc may individuals. It was evident from the results that reduce symptoms of lactic acidosis and rheumatoid people who are HIV positive were not given the arthritis [17]. Fruits also provide vitamins that recommended intake of essentials. A seven day support drug detoxification and reduce ARV drug dietary regimen cyle for HIV positive people was after effects such as nausea, exhaustion, loss of then recommended (Table 3). The suggested diet was appetite and impairment of immune response. based on digestibility of foods and reaction of 17 out of the 20 respondents used cooking oil for different foods to ARVs. It was also recommended preparing meals, Only 3 respondents used fats as that respondents need to have regular light exercises. spread such as butter, margarine and peanut butter since consuming too much fat might result in
Table 3: The dietary regimen that the researcher recommends for people who are HIV positive.
Millet porridge with Unpolished rice, Lean meat, covo, peanut butter, boiled milk, orange juice, Mealie meal porridge Sadza, Beef stew, Rice with peanut with wheat bran, guava Sorghum porridge with Rice, fish fillet vegetable salad, Millet porridge, boiled Sadza, kapenta fish Fruit salad, ice dumplings, lean meat stew pineapple Butternut, crisp, Mashed butternut, Potatoes, termites, Nuts, banana porridge, guava juice CONCLUSIONS
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Usai T, Tshalibe R. S, Nyamunda B. C / International Journal of Engineering Research and
Applications (IJERA) ISSN: 2248-9622 www.ijera.com
Vol. 3, Issue 4, Jul-Aug 2013, pp.1768-1771
This study has shown that certain ARV drug Z. Buttler, .Fundamentals of diet and combination and unbalanced diet cause lactic nutrition, (Oxford: McCrawhill., 1999). acidosis. Nutritionists and dieticians need to produce and distribute materials that give information on recommended dietary menu plans for HIV positive people on ARVs. There is need for creation of income generating projects that target HIV positive , 1997, 71–80. people who are less fortunate to ensure adequacy of food supply in their homes. There is need to include the glycemic index in predicting the blood in the health profession pre service curriculum glucose response to mixed meals, American information on available HIV/AIDS medication, side Journal of Clinical Nutrition, 43(1), 1986, effects and its alleviation, counseling and testing skills. Counseling needs to be individualized and B.A. Mizock, Lactic acidosis in critical supported with practical written guidelines of illness, Critical care medicine, 20(1), 1992, nutrients and drug interactions. Future studies on the effectiveness of the recommendations in alleviating A. Doyle, .Food toxicology and chemistry, lactate acidosis need to be carried out. Oxford: University Press, 1996. S. Hopewood, .Advanced food science, The researcher would like to appreciate the cooperation received from the medical staff and S. Salpeter, E. Greyber, G. Pasternak and E. people who were HIV positive at Mkoba 13 Salpeter, Risk of fatal and nonfatal lactic Polyclinic, without their support and cooperation the acidosis with metformin use in type 2 study would not have been a success. diabetes mellitus, Cochrane Database of Systematic Reviews, 2006, 2967-2979. REFERENCES
E.M. Sillos, J.L. Shenep and G.A. Burghen, Lactic acidosis: a metabolic complication of andLactic acidosis in HIV hematologic malignancies: case report and infected patients: a systematic review of review of the literature, Cancer, 92, 2001, published cases, Sexually Transmmited Infections, 79, 2003, 340-343. A.S. Friedenberg, D.E. Brandoff, F.J. T.M. Devlin, Biochemistry with clinical Schiffman, Type B lactic acidosis as a correlations, (Pennsylvania: John Wiley and severe metabolic complication in lymphoma and leukemia: a case series from a single D.S. Fraley, S. Adler, F.J. Bruns, and B. institution and literature review, Medicine Zett, Stimulation of lactate production by (Baltimore), 86, 2007, 225-237. administration of bicarbonate in a patient with a solid neoplasm and lactic acidosis, Micronutrient supplementation in adult New England Journal of Medicine, 303, nutrition therapy: practical considerations, 1980 303:1100-1111. Journal of Parenter and Enteral Nutrition, G. Friedman, G. Berlot, R.J. Kahn and J. 33(5), 2009, 548-562. Vincent, Combined measurements of blood lactate intramucosal pH in patients with severe sepsis, Critical Care Medicine, 3(7), 1995, 1184-1193. G.M. Glew, .Biochemistry a clinical approach, (Pennsylvania: John Wiley and Sons, 1996). H. Silverman, Food nutrition health, (Oxford: Symour Press Ltd, 1992). voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination mathematical model, The Lancet, 373, 2009, 48-57. 1771 P a g e

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