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CASE 1

CASE 1 . 68 yo man HIV+…1988 HepBsAg (+) HepBeAg (+) No baseline HBV DNA/Liver Biopsy Secondary workup for liver disease negative. CASE 1 . 3TC-based HIV therapy from 1997-2001 CD4 630/37% HIV Viral load <50. CASE 1 .

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CASE 1

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  1. CASE 1 • 68 yo man • HIV+…1988 • HepBsAg(+) HepBeAg (+) • No baseline HBV DNA/Liver Biopsy • Secondary workup for liver disease negative

  2. CASE 1 • 3TC-based HIV therapy from 1997-2001 • CD4 630/37% • HIV Viral load <50

  3. CASE 1 • Tenofovir added to HIV medications (including 3TC) in response to elevated HBV DNA on 3TC monotherapy…no biopsy or assessment of fibrosis done but no obvious cirrhosis/portal hypertension

  4. CASE 1 Fenofibrate/Ramipril/Tenofovireod therapy

  5. CASE 1 • Dec 2010 – Apr 2011 • Fenofibrate/Ramipril/Tenofovireod discontinued in 1/11 WHAT IS GOING ON? WOULD WOULD YOU DO?

  6. CASE 1 • Renal biopsy performed due to blood in urine, increased proteinuria and increasing creatinine • Interstitial fibrosis/tubular atrophy • 2/9 glomerulisclerosed • Mild arterial sclerosis • No active disease Probably an ischemic insult

  7. CASE 1 May 2011– Nov 2011 No Tenofovir/Ramipril/Fenofibrate

  8. CASE 1 • HepBeAg (+), 3TC based HIV therapy • U/S –fatty liver

  9. CASE 1 • Fibrotest 0.74 → F3 scarring • Fibroscan in agreement HOW WOULD YOU MANAGE HIS HEPATITIS B?

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