Bench-to-bedside review: Severe lactic acidosis in HIV patients treated with nucleoside analogue reverse transcriptase inhibitors

Table 1 Cellular effects of nucleosidic reverse transcriptase inhibitors (NRTIs) and carnitine

	Toxicity of NRTIs	References	Effect of carnitine	References
Metabolism	Impairment of β-oxidation cycle	[1]	Long-chain fatty acids carrier	[55]
	Accumulation of long-chain fatty acids into the cytosol	[34]	Protection of cytochrome c oxidase from octanoic acid-induced damage	[61]
	Decrease in ATP concentration	[32]	Cofactor of the electron chain from complex I-V	[60]
	Decreased electron-chain transport	[32]
	γDNA polymerase damage	[33]
	NAD⁺/NADH impairment
Apoptosis	Increased apoptosis	[36–38]	Decreased global apoptosis	[44–46]
	Overexpression of the receptor Fas	[38]	Decreased ceramide generation	[46, 49–52]
			Decreased mitochondrial apoptosis	[49]
			Link with Bcl2?	[50]

NAD⁺, nicotinamide adenine dinucleotide; NADH, reduced form of nicotinamide adenine dinucleotide

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