PrEP and bad news

[concerned1]

I went to the sexual health clinic today and i got 3 more months supply of PrEP. 

But some bad news. The nurse asked me if I have ever been vaccinated against Hep B, and I said yes. I had the full course of 3 injections in 2013. I told him this, and he said "Well it hasn't worked very well. You've got very low immunity." And he said my number was 17. I didn't understand and I asked him what that meant. Basically, he said anything between 0 and 10 means you've got no immunity...and over 100 means you have strong immunity. So at 17, I have very low immunity. So I'm having to go through another 3 jabs for the Hep B. 

And this isn't all. He said my liver function tests (which had been taken during my initial PrEP consultation) had shown creatinine levels which were very high...112. I said I was concerned and he said "yes, you are right to be. It could indicate you have something seriously wrong with your kidneys, I'm afraid"....and he did some rapid testing of my urine but fortunately it showed nothing serious going on. He did say that it will have to be closely monitored, that he hoped creatinine levels will go down but it's not garaunteed that they will...he said if they remain this high over a long period of time or even if they go up, then he will refer me to a doctor who he said will most likely seriously consider whether I should come off PrEP  

We'll have to see what happens. So I learned I'm not protected against Hep B like I thought I was AND that there's a strong possibility that I might have to come off PrEP soon. What sad news to recieve after being on PrEP for only 3 months and just as I've started to enjoy barebacking without any fear or anxieties (due to being on PrEP).  

[Guest Memphian]

I feel for you. Dr. told me to stop PrEP a while back due to some bloodwork.  I need to follow up with my regular doctor because the findings my PrEP provider was concerned about don’t show up in any of the literature on PrEP side effects I can find. So there is a chance I can go back on PrEP. 

But I haven’t stopped barebacking and I admit the thrill is a lot hotter. 

[thkpc]

I had the same issue with creatinine levels when I started Prep.  Mine resulted from working out and taking a creatine supplement.  Creatinine is a by product from muscle break down and gets flushed out via your kidneys.  I went off prep for three months and backed off the supplements.  Also I increase my water consumption.  All this at the direction of my doctor.  After the 90 days I was back to normal and restarted prep.  Now I cycle prep.  I am more active in the summer so I'll go back on Prep in May and quit in October.  Don't despair you'll get it sorted out.

[M4mnow2]

I’ve just gone through the same thing. I had a number of escalations in my kidney, blood etc. was suggested I stop PrEP and go “on demand”, I wasnt comfortable doing that. I increased my fluid consumption and at my recent check up,  last week, everything had returned to normal! Don’t worry about it, do a little resource and increase fluids!

[rawfuckr]

7 hours ago, concerned1 said:

I went to the sexual health clinic today and i got 3 more months supply of PrEP. 

But some bad news. The nurse asked me if I have ever been vaccinated against Hep B, and I said yes. I had the full course of 3 injections in 2013. I told him this, and he said "Well it hasn't worked very well. You've got very low immunity." And he said my number was 17. I didn't understand and I asked him what that meant. Basically, he said anything between 0 and 10 means you've got no immunity...and over 100 means you have strong immunity. So at 17, I have very low immunity. So I'm having to go through another 3 jabs for the Hep B. 

And this isn't all. He said my liver function tests (which had been taken during my initial PrEP consultation) had shown creatinine levels which were very high...112. I said I was concerned and he said "yes, you are right to be. It could indicate you have something seriously wrong with your kidneys, I'm afraid"....and he did some rapid testing of my urine but fortunately it showed nothing serious going on. He did say that it will have to be closely monitored, that he hoped creatinine levels will go down but it's not garaunteed that they will...he said if they remain this high over a long period of time or even if they go up, then he will refer me to a doctor who he said will most likely seriously consider whether I should come off PrEP  

We'll have to see what happens. So I learned I'm not protected against Hep B like I thought I was AND that there's a strong possibility that I might have to come off PrEP soon. What sad news to recieve after being on PrEP for only 3 months and just as I've started to enjoy barebacking without any fear or anxieties (due to being on PrEP).  

*your kidney function tests

It's definitely odd that your ABs to Hep B have come down after only 6 years, but not unheard off. It's good to check from time to time. Just revaccinate yourself. HPV too!

112 on creatine clearance is high but not that high ... I think a million of things could explain the result. Just recheck again in a while.

[rawfuckr]

5 minutes ago, M4mnow2 said:

I’ve just gone through the same thing. I had a number of escalations in my kidney, blood etc. was suggested I stop PrEP and go “on demand”, I wasnt comfortable doing that. I increased my fluid consumption and at my recent check up,  last week, everything had returned to normal! Don’t worry about it, do a little resource and increase fluids!

There is lots of evidence now in 2019 that on demand works as well as daily for men bottoms and load-taking. (no data for women or trans)  for those concerned on short or long term side effects 2-1-1 deserves a hard look

 

[M4mnow2]

Yes, they explained it to me, only challenge is planning it out, knowing when you are going to be active etc. 

[timfreo]

Just stop prep. It's nothing more than a chemical condom

[Guest]

Maybe I’m missing something but a creatinine clearance of 112 is within normal values.

on my lab values it ranges from 70-1.25 before being flagged 

Edited March 21, 2019 by Kennethk13

[DaddyBare]

Why worry about Hep B (I'm a non-responder completely!), when Hep C, for which there is no vaccine, is a far worse disease.

[wood]

On 3/15/2019 at 8:02 PM, rawfuckr said:

*your kidney function tests

It's definitely odd that your ABs to Hep B have come down after only 6 years, but not unheard off. It's good to check from time to time. Just revaccinate yourself. HPV too!

112 on creatine clearance is high but not that high ... I think a million of things could explain the result. Just recheck again in a while.

This is a good response. And it’s important to remember that anyone puts tons of things in your body that can effect other parts of your health including liver and kidney function. Biggest thing you probably need to do is drink a lot more water.

I’d also stay away from most workout supplements. In the US, they are essentially unregulated and many contain compounds that taken in excess are very harmful. Hell GHB was originally a workout supplement legally sold in the US. That’s how crazy the regulation is here. 

Don’t freak out here though and if you are having a lot of sex, don’t go off prep now. I remember your posts before and you were a wreck with worrying. 

[Guest GoneFishing]

On 3/15/2019 at 10:50 PM, timfreo said:

Just stop prep. It's nothing more than a chemical condom

Now that’s a good one!  Chemical condom.  Cleaver !  ☣️

[srider]

On 3/15/2019 at 1:30 PM, concerned1 said:

I went to the sexual health clinic today and i got 3 more months supply of PrEP. 

But some bad news. The nurse asked me if I have ever been vaccinated against Hep B, and I said yes. I had the full course of 3 injections in 2013. I told him this, and he said "Well it hasn't worked very well. You've got very low immunity." And he said my number was 17. I didn't understand and I asked him what that meant. Basically, he said anything between 0 and 10 means you've got no immunity...and over 100 means you have strong immunity. So at 17, I have very low immunity. So I'm having to go through another 3 jabs for the Hep B. 

And this isn't all. He said my liver function tests (which had been taken during my initial PrEP consultation) had shown creatinine levels which were very high...112. I said I was concerned and he said "yes, you are right to be. It could indicate you have something seriously wrong with your kidneys, I'm afraid"....and he did some rapid testing of my urine but fortunately it showed nothing serious going on. He did say that it will have to be closely monitored, that he hoped creatinine levels will go down but it's not garaunteed that they will...he said if they remain this high over a long period of time or even if they go up, then he will refer me to a doctor who he said will most likely seriously consider whether I should come off PrEP  

We'll have to see what happens. So I learned I'm not protected against Hep B like I thought I was AND that there's a strong possibility that I might have to come off PrEP soon. What sad news to recieve after being on PrEP for only 3 months and just as I've started to enjoy barebacking without any fear or anxieties (due to being on PrEP).  

You may want a second opinion on both of those suggestions. This is not medical advice, and there may be specific circumstances that lead the nurse to their conclusions, but it doesn't seem in line with current best practice for HBV vaccination and kidney function. 

[concerned1]

17 hours ago, srider said:

You may want a second opinion on both of those suggestions. This is not medical advice, and there may be specific circumstances that lead the nurse to their conclusions, but it doesn't seem in line with current best practice for HBV vaccination and kidney function. 

Can you explain what you mean exactly by not in line with current practice?

[tallslenderguy]

Here's an explanation of creatinine levels and what it means from an authoritative source (the Mayo Clinic)... which is not to suggest some of the commenters are wrong, just wanted to offer an independent source that everyone can confirm as reliable.

Results of the creatinine blood test are measured in milligrams per deciliter or micromoles per liter. The normal range for creatinine in the blood may be 0.84 to 1.21 milligrams per deciliter (74.3 to 107 micromoles per liter), although this can vary from lab to lab, between men and women, and by age. Since the amount of creatinine in the blood increases with muscle mass, men usually have higher creatinine levels than do women.

Generally, a high serum creatinine level means that your kidneys aren't working well. Your creatinine level may temporarily increase if you're dehydrated, have a low blood volume, eat a large amount of meat or take certain medications. The dietary supplement creatine can have the same effect.

i'm a critical care nurse and look at this number daily on all my patients to check kidney function. i'm used to looking at the milligrams per deciliter number which is used by the hospital blood tests where i work. Along with that number, i look at GFR (glomerular filtration rate). There are five stages to kidney disease before a person reaches failure and has to go on dialysis, and that is based on GFR. For instance, a GFR of 60-90 is considered stage one kidney disease and "mild."  Once GFR hits 15 and below, one is considered in kidney failure.  Kidney failure can be acute or chronic. i had a patient this week who started out with a creatinine level of 2.20 and GFR of 29 on Tuesday and by Thursday his creat was 1.90 and his GFR 35.  i've had many patients come in with ARF (acute renal failure) with a GFR <15, usually older people who fell and broke a hip and couldn't get to water for a few days and got dehydrated, who we were able to get back to normal ranges with hydration.  Dehydration means you aren't urinating as often, thus not getting rid of creatinine, e.g., a metabolite of muscles, so it builds up in the blood and presents in a blood test.  As another has noted, physical exercise can increase creatinine levels, it's a normal waste product of muscle metabolism that can be used as a marker for kidney function because our kidneys are how the body gets rid of that waste.

Bottom line is, lots of things can cause a bump in Creatinine. The kidneys are redundant. Each one has ~1m filters (nephrons), very tiny, complex structures that regulate urine production, get rid of waste.  A person can go their whole life with just one and never notice. However, creatinine and GFR are tests that reflect the health of both kidneys, so we pay attention when there's a bump and  retest to see if it's a trend or a bump in time.  Type 2 diabetes and hypertension can also harm kidneys, and they're common, so it's also important to not ignore or self diagnose.  Go to a doc and get tested and diagnosed for the real cause if there is a chronic condition you need to be aware of.

The good news is your kidneys are still in a good place,  please don't wait to see if they get worse before you get yourself checked.