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VIRTUAL MEDZONE. Your Resource for HIV Related Innovative Medical Communication. HIV CASE PRESENTATIONS. Steven Shafran MD FRCPC Anne Marie Zajdlik MD CCFP David Fletcher MD FRCPC. CASE 2. 78 yo man HIV+ 1990 CD4 on diagnosis 700. CASE 2.

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VIRTUAL MEDZONE

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VIRTUAL MEDZONE

Your Resource for HIV Related Innovative Medical Communication


HIV CASE PRESENTATIONS

Steven Shafran MD FRCPC

Anne Marie Zajdlik MD CCFP

David Fletcher MD FRCPC


CASE 2

  • 78 yo man

  • HIV+ 1990

  • CD4 on diagnosis 700


CASE 2

  • ABC+3TC/Nevirapine & TMP/SMX initiated in 02/03-05

  • CD4 up to 425 from 200

  • VL <50 x3 then 73, 424, 55


CASE 2

  • ABC+3TC/NVP…11/05

  • CD4 220

  • VL 14,026

  • Incomplete Adherence


CASE 2

GENOTYPE NOV/05


CASE 2

  • Patient pleaded with physician to not switch his ARVS out of fear of new side effects

  • Told to improve adherence and F/U in 6 weeks, but 4 months passes


CASE 2

  • ABC/3TC/Nevirapine…4/06

  • VL <50 CD4 260 WHAT?...WHY?...HOW?


CASE 2

  • ABC+3TC/NVP 2006-2007

    • VL <50, 435, 140, <50

    • CD4 260 → 300

  • Intermittent non-adherence


CASE 2

  • ABC+3TC/Nevirapine..2007-2008

    • VL 4564, 105, 6201

    • CD4 200 → 250

  • more non-adherence


CASE 2

GENOTYPE MAR/07


CASE 2

  • Once again, a switch in therapy was discussed at length, but decided on a retry of ABC+3TC/Nevirapine

  • 2008-10

    • VL <50x8, 142, 745

    • CD4 240 → 320


CASE 2

  • June 2010 ABC+3TC/Nevirapine

    • VL 412, 1745

    • CD4 230, 180

  • Incomplete adherence

  • Genotype unchanged

  • What would you do?


CASE 2

  • ABC+3TC/Nevirapine…August 2010

    • VL <50

    • CD4 260

    • Continue as is


CASE 2…Follow-up

  • ABC+3TC/Nevirapine…March 2011

    • VL <39 x 2 !!!!!

    • CD4 320

    • Continue as is !


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