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CASE PRESENTATIONS. David Fletcher MD FRCPC Benny Chang MD CCFP Fred Crouzat MD CCFP. CASE 1. 64 yo man HIV+ 1992 CD4 on diagnosis…40 Asymptomatic. CASE 1. ARV HISTORY. CASE 1. ARV HISTORY. CASE 1. July/09 Syphilis…treated

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CASE PRESENTATIONS

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Case presentations

CASE PRESENTATIONS

David Fletcher MD FRCPC

Benny Chang MD CCFP

Fred Crouzat MD CCFP


Case 1

CASE 1

  • 64 yo man

  • HIV+ 1992

  • CD4 on diagnosis…40

  • Asymptomatic


Case 11

CASE 1

ARV HISTORY


Case 12

CASE 1

ARV HISTORY


Case 13

CASE 1

  • July/09 Syphilis…treated

  • Aug/09… drug holiday - ran out of meds while on vacation


Case 14

CASE 1

  • Upon return in Sept/09… CD4 650 and VL 2668 off meds


Case presentations

CASE 1

GENOTYPE SEPT/09


Case 15

CASE 1

  • Reinitiation of ABC+3TC/RTV/Atazanavir 09/09 -01/10

  • VL 2668 → 567, 627, 601

  • CD4 500 → 650


Case presentations

CASE 1

GENOTYPE JAN/10


Case 16

CASE 1

  • ABC+3TC+AZT 01/10 – 3/10

  • VL 695 CD4 540 (unchanged from previous RTV/ATZ regime)

  • RTV/Darunavir/Raltegravir/Etravirine 3/10-7/10


Case 17

CASE 1

  • RTV/Darunavir/Raltegravir/Etravirine

  • VL 695 → 373 (4/10), 386(5/10), 362(6/10), 267 (7/10)

  • CD4 540 → 670

  • Asymptomatic syphilis in 06/10


Case 18

CASE 1

  • RTV/Darunavir/Raltegravir/Etravirine (7/10)

  • VL 267

  • CD4 540

  • Why?...

  • What do you do next?


Case 19

CASE 1

  • Genotype Tropism Testing…R5

  • Integrase Resistance Pending


Case 110

CASE 1

Patient is currently off HIV medications…What do you restart?


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