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CASE PRESENTATIONS

CASE PRESENTATIONS

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CASE PRESENTATIONS

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  1. CASE PRESENTATIONS David Fletcher MD FRCPC Benny Chang MD CCFP Fred Crouzat MD CCFP

  2. CASE 1 • 64 yo man • HIV+ 1992 • CD4 on diagnosis…40 • Asymptomatic

  3. CASE 1 ARV HISTORY

  4. CASE 1 ARV HISTORY

  5. CASE 1 • July/09 Syphilis…treated • Aug/09… drug holiday - ran out of meds while on vacation

  6. CASE 1 • Upon return in Sept/09… CD4 650 and VL 2668 off meds

  7. CASE 1 GENOTYPE SEPT/09

  8. CASE 1 • Reinitiation of ABC+3TC/RTV/Atazanavir 09/09 -01/10 • VL 2668 → 567, 627, 601 • CD4 500 → 650

  9. CASE 1 GENOTYPE JAN/10

  10. CASE 1 • ABC+3TC+AZT 01/10 – 3/10 • VL 695 CD4 540 (unchanged from previous RTV/ATZ regime) • RTV/Darunavir/Raltegravir/Etravirine 3/10-7/10

  11. CASE 1 • RTV/Darunavir/Raltegravir/Etravirine • VL 695 → 373 (4/10), 386(5/10), 362(6/10), 267 (7/10) • CD4 540 → 670 • Asymptomatic syphilis in 06/10

  12. CASE 1 • RTV/Darunavir/Raltegravir/Etravirine (7/10) • VL 267 • CD4 540 • Why?... • What do you do next?

  13. CASE 1 • Genotype Tropism Testing…R5 • Integrase Resistance Pending

  14. CASE 1 Patient is currently off HIV medications…What do you restart?