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VIRTUAL MEDZONE

VIRTUAL MEDZONE. Your Resource for HIV Related Innovative Medical Communication. CASE PRESENTATIONS. Chris Steingart MD FRCPC John MacLeod MD CCFP David Fletcher MD FRCPC. CASE 1. 46 y.o. man HIV + 2006 CD4 290 HIV VL 59,246 HLAB5701 positive. CASE 1. BASELINE GENOTYPE. CASE 1.

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VIRTUAL MEDZONE

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  1. VIRTUAL MEDZONE Your Resource for HIV Related Innovative Medical Communication

  2. CASE PRESENTATIONS Chris Steingart MD FRCPC John MacLeod MD CCFP David Fletcher MD FRCPC

  3. CASE 1 • 46 y.o. man • HIV+ 2006 • CD4 290 • HIV VL 59,246 • HLAB5701 positive

  4. CASE 1 BASELINE GENOTYPE

  5. CASE 1 WHAT WOULD YOU TREAT WITH?

  6. CASE 1 2007 TDF+FTC/Lopinavir/RTV initiated • CD4 290 increased to 400 • HIV VL <50

  7. CASE 1 2007-2008 TDF+FTC/Lopinavir/RTV • GI Intolerance • Triglycerides 11.5 mmol/l despite optimal management • Cholesterol 8 mmol/l … LDL ? • Previously normal lipids WHAT WOULD YOU DO?

  8. CASE 1 2008 TDF+FTC/RTV/Atazanavir • Jaundice • Lipids remain abnormal and unchanged!!! WHAT WOULD YOU DO?

  9. CASE 1 2009 TDF+FTC/RTV/Darunavir • Lipids remain abnormal • ’d albumin/creatinine ratio to 90 (N<2) • 24 hr urine 2.534 g/day (N<250 mg) • 24 hr creatinine clearance 60 ml/min (N>97 ml/min) WHATS GOING ON? WHAT WOULD YOU DO?

  10. CASE 1 2009/10 Tropism R5 3TC/Etravirine/Maraviroc/Raltegravir • CD4 540-610 HIV VL <50 x 3 • Cholesterol 3.83 mmol/l • LDL 1.68 mmol/l

  11. CASE 1 2009/10 3TC/Etravirine/Maraviroc/Raltegravir Albumin/creatinine ratio… 1 24 hr urine protein…150mg/day 24 hr creatinine clearance… 96 ml/min

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