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CASE PRESENTATIONS

CASE PRESENTATIONS. David Fletcher MD FRCPC Benny Chang MD CCFP Fred Crouzat MD CCFP. CASE 2. 78 yo man HIV+ 1990 CD4 on diagnosis 700. CASE 2. ABC+3TC/ Nevirapine & TMP / SMX initiated in 02/03-05 CD4 up to 425 from 200 VL <50 x3 then 73, 424, 55. CASE 2. ABC+3TC/NVP…11/05

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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 2 • 78 yo man • HIV+ 1990 • CD4 on diagnosis 700

  3. CASE 2 • ABC+3TC/Nevirapine & TMP/SMX initiated in 02/03-05 • CD4 up to 425 from 200 • VL <50 x3 then 73, 424, 55

  4. CASE 2 • ABC+3TC/NVP…11/05 • CD4 220 • VL 14,026 • Incomplete Adherence

  5. CASE 2 GENOTYPE NOV/05

  6. CASE 2 • Patient pleaded with physician to not switch his ARVS out of fear of new side effects • Told to improve adherence and F/U in 6 weeks, but 4 months passes

  7. CASE 2 • ABC/3TC/Nevirapine…4/06 • VL <50 CD4 260 WHAT?...WHY?...HOW?

  8. CASE 2 • ABC+3TC/NVP 2006-2007 • VL <50, 435, 140, <50 • CD4 260 → 300 • Intermittent non-adherence

  9. CASE 2 • ABC+3TC/Nevirapine..2007-2008 • VL 4564, 105, 6201 • CD4 200 → 250 • more non-adherence

  10. CASE 2 GENOTYPE MAR/07

  11. CASE 2 • Once again, a switch in therapy was discussed at length, but decided on a retry of ABC+3TC/Nevirapine • 2008-10 • VL <50x8, 142, 745 • CD4 240 → 320

  12. CASE 2 • June 2010 ABC+3TC/Nevirapine • VL 412, 1745 • CD4 230, 180 • Incomplete adherence • Genotype unchanged • What would you do?

  13. CASE 2 • ABC+3TC/Nevirapine…August 2010 • VL <50 • CD4 260 • Continue as is

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