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CASE 2 . 59 yo WF, HIV+ since 2001 PCP, esophageal candidiasis, CD4 40, VL >200,000 Antiretroviral history: 2001-03: Combivir , NFV. weight gain 2003-08: AZT, 3TC, ABC. Adherence issues (BID);  VL, TAMS/184V. CASE 2 . Antiretroviral history cont…:

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case 2
CASE 2
  • 59 yo WF, HIV+ since 2001
    • PCP, esophageal candidiasis, CD4 40, VL >200,000
  • Antiretroviral history:
    • 2001-03: Combivir, NFV. weight gain
    • 2003-08: AZT, 3TC, ABC. Adherence issues (BID);  VL, TAMS/184V.
case 21
CASE 2
  • Antiretroviral history cont…:
    • 2008: TDF/FTC, efavirenz. CNS effects
    • 2008: ABC/3TC, atazanavir. VL 
    • 2012: TDM: low ATV, CD4 296, VL 6601
case 22
CASE 2
  • Genotype (02/2012):
    • RTI: 184V, 4 TAMS (TDF partially active)
    • NNRTI: 103N (ETV active). PI:  response to ATV. Tropism: non-R5
  • Rx TDF/FTC, darunavir/r
    •  LFTs; d/c DRVr
    • does not want BID regimen (adherence)
  • Possibility of going back on ATVr with an NNRTI?
case 23
CASE 2
  • Initiate:
    • ATV 300/100 mg
    • ETV 400 mg QD
    • TDF/FTC daily
  • Monitor bilirubin, lipids, adherence
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