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HIV Medical Communication: Case Presentations

Explore a detailed case study of a 58-year-old man living with HIV, his treatment journey, complications, and management options over the years. Understand the challenges and decisions in providing care for HIV patients with various comorbidities. Stay informed with innovative medical solutions for HIV-related issues.

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HIV Medical Communication: Case Presentations

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

  2. CASE PRESENTATIONS MahinBaqi MD FRCPC Ken Logue MD David Fletcher MD FRCPC

  3. CASE 1 • 58 y.o. man • HIV + 1989 • CD4 200 on diagnosis • Previous history of depression and chronic intermittent diarrhea

  4. CASE 1

  5. CASE 1 • 2001 stopped meds due to neuropathy, ongoing viremia and chronic diarrhea • CD4 104 HIV VL 266, 131 c/ml • No genotype available

  6. CASE 1 • Restarted AZT/3TC/Abacavir/Lopinavir/ Amprenavir/Nevirapine

  7. CASE 1 GENOTYPE SEPTEMBER2001

  8. CASE 1

  9. CASE 1 • AZT/3TC/Abacavir/Lopinavir/Amprenavir/Nevirapine/Fenofibrate/Fish oil/Niacin

  10. CASE 1 AZT/3TC/Abacavir/Lopinavir/Amprenavir/Nevirapine/Fenofibrate/Fish oil/Niacin • 104 wks… CD4 150 VL 14,895 c/ml • Went to Kingston, Ontario in 2003 to live with partner

  11. CASE 1 • Returned to Toronto in 2005 on D4T/Tenofovir/ddI/Fuzeon • CD4 100 VL 18,295 c/ml

  12. CASE 1 GENOTYPE June 2005

  13. CASE 1 Genotype September 2005

  14. CASE 1 WHAT WOULD YOU DO?

  15. CASE 1 • Tropism Testing…R5 2005-2007 3TC/Maraviroc/Lopinavir/Amprenavir /T20 • CD4 165-250 VL 4,000-10,000

  16. CASE 1 Genotype January 2007

  17. CASE 1 2007 • anal carcinoma in situ • Lipids terrible…Triglycerides >40mmole/l develops pancreatitis, bowel obstruction • ARVS discontinued

  18. CASE 1 Late 2007 3TC/T20/Ritonavir/Darunavir/Etravirine/ Raltegravir/Maraviroc • CD4 30 on initiation

  19. CASE 1

  20. CASE 1 2008 • Develops Diabetes on regimen – Metformin initiated • Triglycerides continue out of control despite bezafibrate/fish oil/crestor • Angina → Severe CAD → CABG

  21. CASE 1 2008 • T20 stopped due to injection site reactions and associated fatigue…viral load remains <50 on 3TC/Ritonavir/Darunavir/ Etravirine/ Raltegravir /Maraviroc

  22. CASE 1 • Lipids remain terrible with TG>40mmole/l • Bezafibrate/fish oil/Ezetrol/Crestor/ ASA/Coumadin • Recurrent angina – 4/5 bypassed vessel restenosed via angiography WHAT WOULD YOU DO?

  23. CASE 1 Late 2008 • Ritonavir/Darunavir discontinued • Remains on 3TC/Maraviroc/Raltegravir /Etravirine • CD4 275 VL <50! • TG 34.70→ 3.78 – 6.07

  24. CASE 1 2009/10 3TC/Maraviroc/Raltegravir/Etravirine • Angina free, mitral regurgitation, Grade 1 LV • CD4 250-275 VL <50! • TG 8.46-6.07 • LDL <0.5 • HDL 0.5-0.6

  25. CASE 1 2010 • Furosemide/Perindopril for mitral regurgitation • Some intermittent orthopnea • Stable angina • New onset prostatism

  26. CASE 1 What would you do ?

  27. CASE 1 • No NSAIDS • No New Meds/holistics/illicit drugs • Not dry on clinical examination • Normotensive • No CHF clinically • No swelling of ankles

  28. CASE 1 • U/S – no obstruction • U/A – normal albumin/creatinine + protein/creatinine ratio • Urinalysis normal • Urine sodium-100 mmol/l CAUSE? MANAGEMENT?

  29. CASE 1 Perindopril + Furosemide discontinued EGFR 45-50 ml/min

  30. CASE 1 Given sudden onset, bland urinalysis and lack of significant proteinuria, likely cause is vascular …awaiting MRI Angiography of kidneys

  31. CASE 1 Doses of all medications readjusted for renal dysfunction Not required for 3TC/Maraviroc/Raltegravir/ Etravirine

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