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Case Discussion: Complications after ART

Case Discussion: Complications after ART. Weerawat Manosuthi, MD Department of Medicine Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, Thailand. Case: SW, 55 year-old male . Case: SW, 55 year-old male . Q1: Do you agree with this regimen “ TDF+3TC+LPV/ r ” ?

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Case Discussion: Complications after ART

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  1. Case Discussion:Complications after ART Weerawat Manosuthi, MD Department of Medicine Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, Thailand

  2. Case: SW, 55 year-old male

  3. Case: SW, 55 year-old male Q1: Do you agree with this regimen “TDF+3TC+LPV/r” ? I do I do not

  4. Case: SW, 55 year-old male

  5. Case: SW, 55 year-old male Q2: What is the most likely cause of renal impairment? Tenofovir Lopinavir/rtv Anti-TB drugs Diabetes 5. Others

  6. Risk Factors Associated with TDF-Induced Nephrotoxicity Mitochondrial toxicity • Older age • Elevated baseline creatinine • Low body weight • Low CD4 nadir • Other comorbidities: diabetes, HCV • Concomitant use of nephrotoxic drugs • Combined therapy with PI • Inhibition of MRP4 by PI/r leads to increased intracellular tenofovir levels • Genetic factors, involving polymorphisms at cellular transporter gene Interfere tubular cell function Rodrı ́guez-No ́voa S, et al. Clin Infect Dis 2009;48:e108-16. KalyesubulaR, et al. AIDS Research and Treatment 2011. Nelson M, et al. AIDS 2008;22,1374-1376. Zimmermann AE, et al. ClinInfect Dis 2006;42,:283-290. Rodrı ́guez-No ́voa S, et al. Expert Opinion 2012;9:545-559.

  7. Case: SW, 55 year-old male Q3: Which of the following is the best next regimen? PI/r + integraseinhibitor + 3TC PI/r + etravirine+3TC PI/r + integraseinhibitor + Etravirine Others

  8. Case: SW, 55 year-old male Q4: Which of the following is a next regimen if he is in the resource-limited setting (3 classes available) ? PI/r + 3TC PI/r + AZT +3TC Others

  9. Case: SW, 55 year-old male

  10. Case: SW, 55 year-old male Q5: What would you manage this episode of TB?

  11. Case: SW, 55 year-old male

  12. Case: SW, 55 year-old male • Q6: Which of the following is the best next regimen? • PI/r + integrase inhibitor + Etravirine • PI/r + integraseinhibitor +3TC • PI/r + 3TC • Others

  13. Case: SW, 55 year-old male

  14. Thank you

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