case presentations
DESCRIPTION
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 VLTRANSCRIPT
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CASE PRESENTATIONSDavid Fletcher MD FRCPCBenny Chang MD CCFPFred Crouzat MD CCFP
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CASE 2• 78 yo man
•HIV+ 1990
• CD4 on diagnosis 700
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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
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CASE 2• ABC+3TC/NVP…11/05• CD4 220• VL 14,026• Incomplete Adherence
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CASE 2GENOTYPE NOV/05
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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
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CASE 2• ABC/3TC/Nevirapine…4/06
• VL <50 CD4 260 WHAT?...WHY?...HOW?
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CASE 2
• ABC+3TC/NVP 2006-2007
• VL <50, 435, 140, <50 • CD4 260 → 300
• Intermittent non-adherence
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CASE 2
• ABC+3TC/Nevirapine..2007-2008
• VL 4564, 105, 6201
• CD4 200 → 250
•more non-adherence
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CASE 2GENOTYPE MAR/07
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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
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CASE 2• June 2010 ABC+3TC/Nevirapine
• VL 412, 1745
• CD4 230, 180• Incomplete adherence•Genotype unchanged
What would you do?
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CASE 2• ABC+3TC/Nevirapine…August 2010
• VL <50
• CD4 260
• Continue as is