Glucose production, oxidation and disposal correlate with plasma lactate levels in HIV-infected patients on HAART Steen B. Haugaard a,b,c, * , Ove Andersen a,c , Sten Madsbad b , Johan Iversen a , Flemming Dela d a Department of Infectious Diseases, Hvidovre University Hospital, DK 2650 Hvidovre, Copenhagen, Denmark b Department of Endocrinology and Internal Medicine, Hvidovre University Hospital, DK 2650 Hvidovre, Copenhagen, Denmark c Clinical Research Unit, Hvidovre University Hospital, DK 2650 Hvidovre, Copenhagen, Denmark d Department of Medical Physiology, Copenhagen Muscle Research Centre, The Panum Institute, University of Copenhagen, DK-2200 Copenhagen, Denmark Accepted 4 January 2006 Available online 17 February 2006 KEYWORDS Lactate; Pyruvate; Hyperinsulinemia; Endogenous glucose production; Glucose oxidation; Normoglycemia; Insulin sensitivity; HIV infection Summary Objectives: Hyperlactatemia is prevalent in HIV-infected patients on highly active antiretroviral therapy (HAART) and may be associated with depletion of mitochondrial DNA. However, the correlation between fasting lactate and mito- chondrial DNA may be weak or absent, implicating that other factors e.g. glucose turnover may contribute to hyperlactatemia. Methods: HIV-infected patients receiving HAART who had lipodystrophy (LIPO, n ¼ 18) or were without lipodystrophy (NONLIPO, n ¼ 18) were investigated. Insulin sensitivity (M-value), glucose oxidation rate (GOX) and fasting endogenous glucose production (EGP) were determined by hyperinsulinemic euglycemic clamp, indirect calorimetry and glucose tracer technique, respectively. Results: Fasting p-lactate (median 1.2 mmol/L; range 0.6e4.3, n ¼ 36) tended to be increased in LIPO (P ¼ 0.12); 6 patients (4 LIPO) had lactate 2.0 mmol/L. Fast- ing lactate correlated inversely with M-value (P < 0.001) and positively with fasting Journal of Infection (2007) 54, 89e97 www.elsevierhealth.com/journals/jinf