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and Research Laboratory |
Biochemistry |
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Division of Biochemistry
In the clinical management of HIV infection, highly
active antiretroviral therapy (HAART) plays a major
role. The success of the treatment achieved mainly through
HAART is tempered significantly by drug toxicities.
These toxicities often occur in patients who have been
exposed to multiple drugs for prolonged periods of time,
thus the monitoring of long-term toxicities is necessary
for the better management of HIV infected individuals.
The main reason for monitoring toxicity is to ensure
the safety for individuals who are on treatment and
identify those who need to stop treatments that are
harmful to their health and change to other treatments.
Biochemistry is a clinical
laboratory service that undertakes biochemical analysis
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provide data, which is used for the diagnosis and monitoring
of HIV disease.
Laboratory analysis of blood (serum and plasma) and body fluids
is performed using advanced scientific instrumentation, such
as Olympus AU 400 Autoanalyzer and Roche AVL 9180 Electrolyte
analyzer. |
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| Olympus
AU400 |
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| Roche
AVL ISE 9180 |
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Quality
Control:
In-House Internal Quality Controls are performed for every
run and these results are plotted on Levy-Jennings charts
and interpreted according to a Westgard Multi-rule algorithm.
We are participating in EQAS with the College of American
Pathologists (CAP), US.
Liver
function tests:
Liver toxicity is a growing problem among HIV patients, particularly
those who are on HAART and among co-infected with hepatitis
C or hepatitis B. Clinicians need to monitor potential symptoms
of liver disease and/or drug-related effects in the patients.
Serum albumin tests look for a protein that is made by the
liver and released into the blood and keep circulating in
the blood rather than being drawn into the tissues. Reduced
levels of albumin suggest that the liver is not functioning
properly.
Low serum albumin is also a marker for poor nutritional status,
and in some populations it may predict progression in HIV
disease. This may be a reason for using the test to identify
people at higher risk who should have priority access to treatment
and other medical and social support.
Bilirubin is a protein released into the blood by the lyses
of red blood cells. Bilirubin is the cause of jaundice, when
a person’s eyeballs and skin go yellow and their urine
is darkened. Jaundice happens when the liver is no longer
doing its job of removing the bilirubin from the blood. Increased
levels of bilirubin can be detected before jaundice is obvious,
suggesting that liver damage is occurring.
Metabolic
Complications:
Cholesterol levels in the blood are raised with long-term
treatment with a number of protease inhibitors currently in
use and possibly with other drugs. Whether this will translate
into a substantial risk of heart disease probably depends
on the extent to which other risk factors (such as cigarette
smoking, family history, etc) are present.
Lactic acidosis is a rare and very serious complication linked
to nucleoside analogues in general although it may be more
common with AZT (Zidovudine), d4T (Stavudine) and ddI (Didanosine)
than with Abacavir or 3TC (Lamivudine). It is caused by damage
to mitochondria - the systems inside cells that generate energy
by combining sugars and oxygen. This makes the body switch
to alternative energy systems that cause lactic acid to build
up in the blood.
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The main symptoms
are fatigue, breathlessness, and liver enlargement. |
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Initial symptoms can include
nausea, lack of appetite and malaise, as well as fatigue
and difficulty in breathing. |
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In lactic acidosis, the liver
may be swollen and tender, and liver enzymes may be
elevated. |
Renal function tests:
Two tests commonly performed to monitor the functioning of
kidneys are Creatinine levels and BUN (Blood Urea Nitrogen)
tests. If elevated, they mean that the kidneys may be damaged.
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