About blood test

[satimis]

Hi folks,

My sister will attend a follow-up consultation on the coming early Nov. I'll advise her to ask her care doctor on the result of blood test in respect of following tests;


1)
BUN test

1a)
Level of blood urea nitrogen

? mg/dL
OR
? mmol/L

1b)
Blood urea nitrogen to creatinine ratio (BUN:creatinine)


Both to find out the kidney function.


2)
ALT (enzyme alanine transaminase) level

? units per liter (U/L)
OR
? international units per liter (IU/L).

To determine the liver damage.


3)
HbsAg (Surface antigen of Hepatitis-B-Virus (HBV))
Posting(reactive)
OR
Negative(non reactive)


4)
HbeAg (hepatitis B "e" antigen)
Positive(reactive)
OR
Negative(non reactive)


5)
HbsAb (Hepatitis B Surface Antibody)
Positive(reactive)
OR
Negative(non reactive)


6)
HbeAb (Antibody to the hepatitis B e antigen.)
Positive(reactive)
OR
Negative(non reactive)


7)
HBV DNA
It may not be tested (only to be tested annually)


Any other tests to add ?  TIA

B.R.
satimis

[stef2011]

1 no entecavir can be used even with people with kidneys disfunction, all drugs are esecreted by kidneys but not all can make kidneys damage, it is totally safe about this.

bun can be elevated for many reasons not related to kidneys, it is the less sensitive for kidneys, lately it has been proposed not to use it any more for this,creatinine and gfr are the tests for it, if you check tenofovir they require creatinine not bun

7 Her response was always "check once a year",
very wrong, just check any guidelines, one year is way too late for a rescue add-on drug, although 1.2% is low somebody will fit in that low and it can potentially be anybody on etv

NUC is any antiretroviral, there have been deaths for lactic acidosis in hbv therapy, although extremely rare and i'd say impossible on a healthy liver better not risk on something which is deadly if not detected on time

[satimis]

Hi Stefano,

Each time in the follow-up consultation her doctor only informed her the result of blood test verbally.  No printed report was issue unless a special written application is submitted, subject to a fee.


1)
> etv has no kidneys toxicity so she might even skip this

Entecavir residue is discharged via kidney increasing the workload of latter.  To have a picture of kidney function BUN test will be the correct procedure.


2)
> not good to determine liver damage ...

She has fibroscan before Etecavir treatment started.  No scar was found, liver being clear of cirrhosis.  High level ALT indicates the possible liver damage.


3)
> hbsag, if quantitative not available ...

I'm not aware of the quantitative test on HbsAg.  I'll inform my sister to ask her doctor.


4), 5) and 6)
OK.  Thanks


7)
> hbvdna, this must be done every 3-6 months to detect resistance ...

I asked my sister in many occasions.  Her response was always "check once a year", her doctor's decision.  He is a specialist, not a clinical doctor.


> you are missing the most important test. lactic acidosis is a severe side of all NUC antivirals ....

Whether you meant follow;
Lactic Acidosis and Hepatic Steatosis
a Simple FactSheet from the AIDS Treatment Data Network
http://www.aegis.com/factshts/network/simple/lactic.html


Lactic Acid Test
http://medical-dictionary.thefreedictionary.com/lactic+acid+test

...  Normally, lactic acid is removed from the blood by the liver. When an excess of lactic acid accumulates for any reason, the result is a condition called lactic acidosis.

(That means if the liver is in problem then the lactic acid in the blood can't be removed resulting in "lactic acidosis"


What is NUC ?


B.R.
satimis

[stef2011]

by the way the normal doctors have very different approch:
at local hospital where i take the free drugs by healthcare system did not require any tests only hbvdna every 3 months at start and then every 6 months while at research center they check much more as suggested above, i do prefer the second ones

[stef2011]

1)
since i had creatinine increase bescause at the hospital they check almost everything every 2-3 months i suggest this for kidneys function:
all tests are not sensitive at all and creatinine can be normal even with loss of 50% Gfr, so best way is to have serum creatinine, phospphate and calcium 2-3 times a year as baseline values and then check every 6 months, in case of increase from baseline go with 24unrine test of creatinine/phosphate/calcium clearance
etv has no kidneys toxicity so she might even skip this, i did because i was using high dose vit D and ntz

2)
not good to determine liver damage, she should do fibroscan every 3months to see improvement in inflammation and fibrosis, in case of no fibroscan she can check these every 6 months or once a year but once etv made them lower than 20 it is very rare to have flactuations again

3)
hbsag, if quantitative not available just check qualitative once a year.
quantitatively is uselfull since about 19-20% lose 0.5-1log per year when hbe is positive at start of therapy.this is much more useful is using ntz or interferon because etv has little impact on this

4) useful only if hbe pos and hbeab neg, once seroconverted not useful to check again

5) useful once a year

6) useful only if hbeab is negative

7) hbvdna, this must be done every 3-6 months to detect resistance (i do it it monthly, guidelines says every 3 months), this is the most important test for starting a rescue drug as soon as resiatnce happens, on etv risk is only 1,2% but better check it anyway

in case of resistance alt are the last to increase, hbcab igm quantitative and hbvdna the first to rise.for those with superupdated labs cccdna positive in serum is the first sign of resistance

you are missing the most important test. lactic acidosis is a severe side of all NUC antivirals, it is very very rare and usually on decompensated cirrhosis only but since this can have no signs and can be deadly if not detected you have better check this every 6 months