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

2. HIV CASE PRESENTATIONS Stephen Shafran MD FRCPC Anne Marie Zajdlik MD CCFP David Fletcher MD FRCPC

3. CASE 1 45 yo man HIV+ 1998 CD4 nadir <10 Multiple antiretroviral regimens over 15 yrs

4. CASE 1 Current regimen: ABC/3TC/RTV/DRV/ETV/RGV/ Rosuvastatin/Nadolol CD4 220 VL<50 x 8 months

5. CASE 1 March 2011 Awakens one morning with significant bilateral leg pain/erythema lasting 3 days No fevers/blistering or migration of erythema

6. CASE 1 March 2011 Described as burning/cramping muscle pain +/- bone pain…not skin/joint pain No joint/leg swelling

7. CASE 1 March 2011 Pain completely gone at clinic visit Noted during pain that feet were cold and pulses were barely palpable ASA 325 mg prn relieved pain within minutes throughout the day

8. CASE 1 March 2011…In the office Examination unremarkable from a neurological, vascular, MSK, and dermatological standpoint Cause???

9. CASE 1 On further detailed history: He had a migraine H/A the evening before and took an OTC migraine pill (in Costa Rica) – Ergotamine/caffeine/Dipirone

10. CASE 1 ERGOTISM!!! – Vascular insufficiency due to spasm – Role of RTV/DRV and Nadolol – Role of ETV