case 1
Post on 05-Jan-2016
28 Views
Preview:
DESCRIPTION
TRANSCRIPT
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 <50DATE HepBeAg ALT AST PLT INR Alb HBV DNA
2001 (+) 78 60 226 1.0 42 1.10x107 IU/ml
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
CASE 1DATE HepB
eAgALT AST INR ALB HBV
DNACREAT
2002 + 41 33 1.0 43 10e3, iu/ml
144
2003 + 35 26 ---- ---- <500 1432004 + 28 39 1.0 45 <500 1462009 (-) 36 28 0.9 43 <12 1492010 (-)
eAb + 31 32 1.0 48 <12 154
Fenofibrate/Ramipril/Tenofovir eod therapy
CASE 1
DATE CREAT U/A PROT/CREAT U/S
08/10 151 +glu, pro 1g/l 0.365 g/l -----
12/10 294 +glu, pro 2g/l 2+ blood
1.17 g/l Normal kidneys
02/11 277 ------ ------ ------
04/11 390 ------ 0.916 g/l ------
Dec 2010 – Apr 2011• Fenofibrate/Ramipril/Tenofovir eod
discontinued in 1/11
WHAT IS GOING ON?WOULD WOULD YOU DO?
CASE 1
• Renal biopsy performed due to blood in urine, increased proteinuria and increasing creatinine
• Interstitial fibrosis/tubular atrophy• 2/9 glomeruli sclerosed• Mild arterial sclerosis• No active diseaseProbably an ischemic insult
CASE 1
DATE CREAT PROT/CREAT ALB/CREAT
05/11 232 0.916 g/l 3007/11 189 ------ -------09/11 179 ------ ------11/11 177 0.562 g/l 20
May 2011– Nov 2011No Tenofovir/Ramipril/Fenofibrate
CASE 1
DATE ALT AST HBV DNA02/11 30 27 (-)06/11 30 27 7.36x102 IU/ml07/11 30 26 3.44x105 IU/ml09/11 216 127 ------11/11 78 49 1.44x108 IU/ml
• HepBeAg (+), 3TC based HIV therapy
• U/S –fatty liver
CASE 1
• Fibrotest 0.74 → F3 scarring• Fibroscan in agreement
HOW WOULD YOU MANAGE HIS HEPATITIS B?
top related