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VIRTUAL MEDZONE

VIRTUAL MEDZONE. Your Resource for HIV Related Innovative Medical Communication. HIV CASE PRESENTATIONS. Mike S ilverman MD FRCPC David Fletcher MD FRCPC. CASE 1 . 63 yo man HIV+ 1985 CD4 nadir 42 Previous PCP Anal Squamous Cell Cancer… in remission. CASE 1 . 2007

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VIRTUAL MEDZONE

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

  2. HIV CASE PRESENTATIONS Mike Silverman MD FRCPC David Fletcher MD FRCPC

  3. CASE 1 • 63 yo man • HIV+ 1985 • CD4 nadir 42 • Previous PCP • Anal Squamous Cell Cancer… in remission

  4. CASE 1 2007 • AZT/3TC/Abacavir/RTV/Lopinavir • CD4 650 • Viral load <50

  5. CASE 1

  6. CASE 1 • No family history of liver disease • No alcohol consumption/illicit drug use • No new HIV medications • Vaccinated for Hep A & B

  7. CASE 1 • Fenofibrate initiated in late 2006 for elevated triglycerides…this medication was discontinued in early 2007 with no improvement seen in liver enzymes over the next 2 months

  8. CASE 1

  9. CASE 1 MARCH 2007 • HepAIgG (+) • HepBsAb (+) • HepCAb (-) • Iron studies/secondary liver disease workup negative

  10. CASE 1 MARCH 2007 • HCVRNA and HBVDNA negative • U/S – Enlarged, fatty liver WHAT WOULD YOU DO?

  11. CASE 1 • Lipids optimized • Antiretrovirals switched from AZT/3TC/ ABC/RTV/LPV to ABC/3TC/TDF/ATZ in June/07

  12. CASE 1 ATZ → RTV/LPVr RTV/LPVr → ATZ

  13. CASE 1 2008-2010 • Serial Fibrotest + APRI suggest scarring stability around F 2/4 • No changes on serial U/S

  14. CASE 1 SEPTEMBER 2011 • ABC/3TC/TDF/ATZ • ALT 88 • AST 53 • Fibrotest F3/4 scarring → Progression!!!

  15. CASE 1

  16. CASE 1 WHAT WOULD YOU DO?

  17. CASE 1 PREVIOUS ANTIRETROVIRAL HISTORY • AZT monotherapy • AZT/3TC/SQV with viral load 1500 • AZT/3TC/ABC/RTV/LPVr or ABC/3TC/TDF/ATZ → 3 viral load blips >50 in 8 years • No genotypes available

  18. CASE 1 Which antiretroviral regimen would you choose given fatty liver disease and renal abnormalities?

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