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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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