Biochemistry

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 to
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 Beckman Coulter AU 400/480 Autoanalyzers and Roche AVL 9180 Electrolyte analyzer.

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), USA.

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 uses 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 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.

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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