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CASE 3

CASE 3. 43 yo man HIV+ since 2005 CD4 nadir 190 Baseline genotype…clear. CASE 3. 07/2005 ABC/3TC/RTV/ATZ initiated without problems CD4 increased to 720 HIV viral load <50, 40. CASE 3. CAUSE(S)?? WHAT NEXT??. CASE 3. Hep A & B immune Hep C (-) Secondary liver disease workup (-)

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CASE 3

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  1. CASE 3 • 43 yo man • HIV+ since 2005 • CD4 nadir 190 • Baseline genotype…clear

  2. CASE 3 07/2005 • ABC/3TC/RTV/ATZ initiated without problems • CD4 increased to 720 • HIV viral load <50, 40

  3. CASE 3 CAUSE(S)?? WHAT NEXT??

  4. CASE 3 • Hep A & B immune Hep C (-) • Secondary liver disease workup (-) • No illicit drugs • ++Etoh consumption • BMI 33 • Hyperlipidemia

  5. CASE 3 2005… U/S liver • 20 cm echogenic liver c/w fatty liver • Normal spleen size/no varices

  6. CASE 3 2005… Fatty Liver • Exercise/Weight loss • Cessation of ETOH • Treatment of lipids

  7. CASE 3

  8. CASE 3 Fibroscan12/2013 • 6.5 kpa • CAP 272 dB/m (gd 2/3 fat) • Will follow

  9. CASE 3 ABC/3TC/RTV/ATZ Painless microhematuria

  10. CASE 3 U/S kidney • Normal size kidneys • Normal echotexture • No stones • No obstruction

  11. CASE 3 2013 Inflammatory monoarthropathy of left ankle • No diagnosis, but felt to be crystal induced disease • Significantly increased NSAID use, more chronically (high dose daily) in fall 2013

  12. CASE 3 ABC/3TC/RTV/ATZ CAUSE(S)??

  13. CASE 3 ABC/3TC/RTV/ATZ Role of Renal Biopsy vs waiting??

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