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VIRTUAL MEDZONE

VIRTUAL MEDZONE. Your Resource for HIV Related Innovative Medical Communication. CASE PRESENTATIONS. Chris Steingart MD FRCPC John MacLeod MD CCFP David Fletcher MD FRCPC. CASE 2. 45 y.o . man HIV + 1995 CD4…10 asymptomatic. CASE 2. 1996 Cryptogenic Cirrhosis (biopsy proven)

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VIRTUAL MEDZONE

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

  2. CASE PRESENTATIONS Chris Steingart MD FRCPC John MacLeod MD CCFP David Fletcher MD FRCPC

  3. CASE 2 45 y.o. man HIV+ 1995 CD4…10 asymptomatic

  4. CASE 2 1996 Cryptogenic Cirrhosis (biopsy proven) Hepatitis A & B immune/Hepatitis C Ab & HCV RNA (-) Recurrent ascites/UGI bleeds secondary to gastric/esophageal varices

  5. CASE 2 1996-97 Varices banded & glued Nadolol instituted for secondary prophylaxis of variceal bleeding

  6. CASE 2 2010 No further bleeding or ascites for the past 13 years U/S done q-6 months for hepatoma screening – negative Late 2009 variceal surveillance via OGD reveals very small distal esophageal varices

  7. CASE 2

  8. CASE 2 Genotype MARCH 2000

  9. CASE 2

  10. CASE 2 Genotype MARCH 2008

  11. CASE 2

  12. CASE 2 • On another note

  13. CASE 2

  14. CASE 2 U/S ABDO 10 & 10.9 cm nephrosclerotic kidneys Unchanged in size from 2007 but approximately 1 cm smaller as compared with 2002

  15. CASE 2 • No NSAIDS • No new meds/holistics/herbals • No illicit drugs • Normotensive…no ankle swelling • GFR (C-G) → 35 ml/min!

  16. CASE 2 WHAT IS GOING ON ?? HOW WOULD YOU MANAGE THIS PATIENT ??

  17. CASE 2 • Dosage of ABC/3TC/RTV/ Darunavir/Etravirine/Raltegravirnot adjusted • Nadolol low dose so kept as is

  18. CASE 2 • Hepatitis serology inactive • ANA,C3,C4,CH50, ANCA negative • SIE/UIE negative • BS/HBA1C always normal

  19. CASE 2 • Nephrology consulted regarding renal biopsy

  20. CASE PRESENTATIONS Chris Steingart MD FRCPC John Macleod MD CCFP David Fletcher MD FRCPC

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

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