case 4 53 yo man hiv+ since 1989 cd4 nadir 220. case 4 dateregimencreatinine 1990azt100...
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CASE 4• 53 yo man • HIV+ since 1989
• CD4 nadir 220
CASE 4
DATE REGIMEN CREATININE
1990 AZT 100
1994 AZT/DDI 99
1998 AZT/3TC/IDV 108
1999 AZT/3TC/NFV 95
2004 TDF/AZT/3TC/NFV 102
2009 TDF/AZT/3TC/RTV/LPVr 108
CASE 4
Longstanding chronic active (E ag Positive) Hepatitis B/Cirrhosis
• 3TC resistant
CASE 4
DATE ARV REGIMEN
Creat. ALB/Creat U/A Random Ur. Protein
2004-2010 TDF/AZT/3TC/RTV/LPVr
108 - (-) -
2010 “ 111 7.4 (-) -
02/2011 “ 119 - Tr. Protein -
11/2011 “ 149 14 Tr. Protein -
No obvious reversible inciting cause
CASE 4
DATE Creat. ALB/Creat U/A R. U. Protein11/2011 149 14 Tr. Protein -02/2012 124 <2 - <0.04
Switched to ABC/3TC/AZT/RTV/LPV in 12/11
AST/ALT + HBV DNA !!!!!
CASE 4
DATE Creat. ALB/Creat U/A R. U. Protein04/2012 94 <2 - <0.0405/2012 113 - - -06/2012 108 12.4 >1g/L 1.05407/2012 138 10.4 0.3 g/L -
Restarted TDF/3TC/AZT/RTV/LPV post 04/12 labs
CASE 4
DATE Creat. ALB/Creat U/A R. U. Protein07/2012 138 10.4 0.3 g/L -08/2012 145 10.6 0.3 g/L 0.52309/2012 119 4.6 0.3 g/L 0.998
TDF DOSED TO EVERY OTHER DAY AND RTV/LPV SWITCHED TO RTV/DRV in 7/12
Normal liver enzymesHBVDNA (-)
CASE 4
DATE Creat. ALB/Creat U/A R. U. Protein08/2012 145 10.6 0.3 g/L 0.52309/2012 119 4.6 0.3 g/L 0.99810/2012 122 4.9 0.3 g/L 0.51212/2012 119 4.6 - -03/2013 104 3.2 0.3 g/L 0.52510/2013 108 2.8 0.3 g/L 0.589
SWITCHED TO AZT/3TC/ETR/RGV/TDF eod 10/12
NORMAL LIVER ENZYMESHBV DNA (-)