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VIRTUAL MEDZONE

VIRTUAL MEDZONE. Your Resource for HIV Related Innovative Medical Communication. HIV CASE PRESENTATIONS. Phil Sestak MD David Fletcher MD FRCPC. Case 3. 49 yo man HIV+ 2003 Asymptomatic CD4 290 HIV Viral Load 137,908 HLAB5701 negative Genotype clear. Case 3.

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VIRTUAL MEDZONE

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

  2. HIV CASE PRESENTATIONS Phil Sestak MD David Fletcher MD FRCPC

  3. Case 3 • 49 yo man • HIV+ 2003 • Asymptomatic • CD4 290 • HIV Viral Load 137,908 • HLAB5701 negative • Genotype clear

  4. Case 3 Abacavir/3TC/Ritonavir/Lopinavir initiated • CD4 increased to 770 • Viral Load<39 • Asymptomatic and happy • Can you check my QT interval?

  5. Case 3 • QTc interval on EKG was 470ms (normal 440ms for men) What is the cause ? What would you do ?

  6. Case 3 Causes of QT interval prolongation: • Congenital • Drugs • Electrolyte abnormalities • Heart disease, brain disease, endocrine abnormalities • Often multiple factors involved

  7. Case 3 Risks for Polymorphic Ventricular Tachycardia (Torsades De Pointes): • Women>men • Multiple factors often involved • No definitive rules re: actual QT interval and events but 60ms rise or a QTc of>500ms are concerning but not definitive • Still very rare to get VT and even rarer to die from it

  8. Case 3 HIV and QT interval Prolongation: • May be directly associated with HIV of longer duration • More commonly associated with HIV and concomitant autonomic neuropathy

  9. Case 3 Protease Inhibitors and QT interval Prolongation: • Reported in vitro with Ritonavir/Lopinavir and others (inhibition of hERG) • Reported in vivo with Ritonavir/Saquinavir, Ritonavir/Atazanavir, Ritonavir/Lopinavir

  10. Case 3 Protease Inhibitors and QT interval Prolongation : • not all studies • Often of little consequence (3-20ms ) • may only be early on upon initiation • Discrepancy between in vivo models and in vitro

  11. Case 3 Back to the case • No concomitant medications of concern • Electrolytes were all normal • EKG repeated and QTc interval was 419ms • No action taken other than a f/u EKG next appointment

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