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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 2 . Antiretroviral history cont…:

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CASE 2

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  1. 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.

  2. CASE 2 • Antiretroviral history cont…: • 2008: TDF/FTC, efavirenz. CNS effects • 2008: ABC/3TC, atazanavir. VL  • 2012: TDM: low ATV, CD4 296, VL 6601

  3. 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?

  4. CASE 2 • Initiate: • ATV 300/100 mg • ETV 400 mg QD • TDF/FTC daily • Monitor bilirubin, lipids, adherence

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