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Comprehensive Management of HIV, Hepatitis C, and Renal Complications in a 54-Year-Old Man

This case study follows a 54-year-old man diagnosed with HIV in 1997, presenting with severe opportunistic infections including PCP and Cryptosporidiasis, along with chronic Hepatitis C (Genotype 1a). Initial treatment with D4T/3TC/Indinavir boosted his CD4 count significantly, but he later developed interstitial renal disease linked to indinavir. After several treatment regimens, including Peg Interferon for Hepatitis C, the patient transitioned between various antiretrovirals addressing both HIV and side effects. The case highlights the complexities of managing HIV alongside comorbidities like hepatitis and renal dysfunction.

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Comprehensive Management of HIV, Hepatitis C, and Renal Complications in a 54-Year-Old Man

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  1. CASE 2 • 54 yo man…HIV+ 1997 • PCP • Cryptospordiasis • Chronic HepC • Genotype 1a • Biopsy… 2/4 activity, 3/4scarring • CD4 40 • No baseline genotype

  2. CASE 2 1998-2002 D4T/3TC/Indinavir initiated • CD4 30 → 400 • Viral load undetectable

  3. CASE 2 • U/A - ++ WBC + IDV crystals • Creatinine – 80 → 115 • Indinavir crystal induced interstitial renal disease felt to be responsible

  4. CASE 2 2002-2008 • D4T/3TC/Nelfinavir • Mild intermittent diarrhea • Successfully treated for Hepatitis C with 48 wks of Peg Interferon/RBV • CD4 450-700 VL <50

  5. CASE 2 2008 • D4T/3TC/Nelfinavir • Ongoing diarrhea • Increasing recognition of dorsocervical fat pad • Switched to TDF/FTC/Efavirenz

  6. CASE 2 WHAT WOULD YOU DO?

  7. CASE 2 June 2009 • TDF/FTC/Efavirenz switched to TDF/FTC/Etravirine to attempt to r/o Efavirenz as cause of hepatitis

  8. CASE 2 WHAT WOULD YOU DO?

  9. CASE 2 • TDF/FTC/Etravirine switched to D4T/3TC/Etravirine to attempt to r/o TDF/FTC as rare cause of hepatitis

  10. CASE 2 Sept/09 D4T/3TC/Etravirine WHAT WOULD YOU DO?

  11. CASE 2 • Switched back to TDF/FTC/Etravirine as patient concerned about lipodystrophy and unclear whether liver improving at all from Etravirine or TDF/FTC switch

  12. CASE 2 WHAT IS HAPPENING? WHAT WOULD YOU DO?

  13. CASE 2 • Patient self-discontinues meds

  14. CASE 2 • Restarted TDF/FTC/Efavirenz for simplicity/convenience NOW WHAT?

  15. CASE 2 Late September 2010 • Switched to D4T/3TC/Raltegravir as previously had normal liver enzymes for years on D4T/3TC/Nelfinavir and need to get rid of TDF/FTC and NNRTI class. • Refused PI due to lipohypertrophy STAY TUNED!!!

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