CASE 1 54 yo man HIV+ 2005 Generalized Anxiety/OCD VL 15,185 CD4 ranges from 340 - 390 Baseline Genotype clear.

Slides:

Advertisements

Similar presentations

Unit 6 Diagnosis & Follow-up of HIV Infection

Advertisements

Acute Retroviral Syndrome

Ardis Ann Moe UCLA CARE clinic/NEVHC Van Nuys 21 June 2014

VIRTUAL MEDZONE Your Resource for HIV Related Innovative Medical Communication.

Salvage Antiretroviral Therapy Guiding Principles, Strategies and the Role of Resistance Testing.

1 Lecture 3: Laboratory Diagnostics in ARV Therapy delivered by Dr. Madisa Mine, Botswana Ministry of Health KITSO AIDS Training Program.

Feedback from Pregnancy research group UK CHIC / UK HIV Drug Resistance Database Meeting, 2 July 2010 Pregnancy Group: Jane Anderson, Loveleen Bansi, Susie.

+ Understanding HIV-Related Lab Tests Jordan E. Lake, MD, MSc AAHU August 27, 2014.

HEPATITIS C CO-INFECTION

CASE 1 55 yo man…Baker HIV+ since 1996 Refused bloodwork over the years as was ‘Feeling fine’ Oral hairy leukoplakia noted on oral biopsy in 2001.

VIRTUAL MEDZONE Your Resource for HIV Related Innovative Medical Communication.

Is monitoring for CD4 counts still needed for the management of patients with long- term HIV RNA suppression? Andrew Hill, Liverpool University, UK.

DRAFT BHIVA GUIDELINES Routine monitoring of HIV UK-CAB 31 July 2009 Matt Williams writing committee community rep.

NICE Guidelines on the Use of Ribavirin and Interferon Alpha for Hepatitis C Matt Johnson and Dr. Hunt / Asante / Jenkins.

VIRTUAL MEDZONE Your Resource for HIV Related Innovative Medical Communication.

1 Treatment Failure HAIVN Harvard Medical School AIDS Initiative in Vietnam.

CASE 3 63 yo man HIV positive G1a chronic Hepatitis C… Recent HIV history TDF/FTC/RTV/Atazanavir with CD4 480 and HIV viral load

CASE 2 49 yo man HIV Bipolar 2 disorder highlighted by major depression with a few serious suicide attempts and necessitating multiple hospital admissions.

Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection DR. S.K CHATURVEDI DR. KANUPRIYA CHATURVEDI.

Hepatitis web study Hepatitis web study Ledipasvir-Sofosbuvir in GT1 or GT4 and HIV Coinfection ION-4 Phase 3 Treatment Naïve and Treatment Experienced.

CASE 5 54 yo man HIV positive in 2001 Immune Thrombocytopenia Chronic G1a Hepatitis C Crack use daily Normotensive.

1 ARV Drug Resistance HAIVN Harvard Medical School AIDS Initiative in Vietnam.

Comparison of INSTI vs PI  FLAMINGO  GS  ACTG A5257  WAVES.

1 Monitoring The Patient on ARV Treatment HAIVN Harvard Medical School AIDS Initiative in Vietnam.

CASE 3 43 yo man HIV+ since 2005 CD4 nadir 190 Baseline genotype…clear.

IAS–USA Special Considerations: When and What to Start with Viral Hepatitis Coinfections Joseph J. Eron, Jr, MD Professor of Medicine University of North.

ZIMBABWE AIDS CARE FOUNDATION NEWLANDS CLINIC Virological Outcomes in Adult Patients on Second Line ART, at Newlands Clinic Dr S. Bote.

CASE 3 48 yo man HIV positive/HEP C positive 12 yrs ago Tenofovir/FTC/RTV/Lopinavir x 7 yrs CD4 310/40% HIV Viral Load

Switch to DRV/r monotherapy  MONOI  MONET  PROTEA  DRV600.

+ Understanding HIV-Related Lab Tests Jordan E. Lake, MD, MSc AAHU Sept 1, 2015.

Switch to LPV/r monotherapy  Pilot LPV/r  M  LPV/r Mono  KalMo  OK  OK04  KALESOLO  MOST  HIV-NAT 077.

VIRTUAL MEDZONE Your Resource for HIV Related Innovative Medical Communication.

SPECIAL CONSIDERATIONS August

Transplantation in HIV Michelle Roland, MD Assistant Professor of Medicine UCSF Positive Health Program at SFGH.

Treatment Failure HAIVN Harvard Medical School AIDS Initiative in Vietnam.

CASE 3 48 yo man HIV positive/HEP C positive 12 yrs. ago Tenofovir/FTC/RTV/Lopinavir x 7 yrs. CD4 310/40% HIV Viral Load

CASE 2 54 yo man…HIV PCP Cryptospordiasis Chronic HepC Genotype 1a Biopsy… 2/4 activity, 3/4scarring CD4 40 No baseline genotype.

Karyn Kaplan Thai AIDS Treatment Action Group (TTAG)

Hepatitis C Past, present and future Salil Singh Consultant Gastroenterologist, RBH

Hepatitis C Infection By: S/N Maryam Omar. Introduction  Thalassemia patient require life long blood transfusion to sustain their growth and development.

Comparison of INSTI vs PI  FLAMINGO  GS  ACTG A5257.

CASE 4 44 yo man HIV positive 2010 CD4 400 on diagnosis Initiated Abacavir/3TC/Dolutegravir in /2013 CD4 600 HIV viral load

Viral Hepatitis.

Drug Induced Liver Disease Tutoring

Switch to PI/r monotherapy

eGFR (MDRD) > 50 mL/min

Hepatitis C in MSMs; a review of testing practices in the GUIDe clinic & a description of recent cases N. Lynn*, J Dean**, e quinn**, G Farrell*, C Murray*

What is Hep C Dave Stafford.

In The Name of God.

Switch to PI/r + 3TC vs PI/r monotherapy

ARV-trial.com Switch to ATV/r + 3TC ATLAS-M Study.

Phase 3 Treatment-Naïve and Treatment-Experienced

Pharmacokinetics: HIV Drugs

Validating Definitions of Antiretroviral Treatment Failure in Malawi

Pharmacokinetics: HIV Drugs

Sofosbuvir plus Peg-Interferon and Ribavirin in Treatment Experienced Patients with Hepatitis C Virus and HIV Co-Infection Mehri Nikbin, MD Infectious.

CASE 2 53 yo man HIV CD4 340/16% (Nadir) VL 30,100 c/ml.

Case Definition: HEPATITIS C

VL patient support: General education at different levels

HCV. The Spectrum of Hepatitis C Virus Infection: From Acute Infection to End-Stage Liver Disease.

The Aging Liver in the Aging HIV and HCV Patients

Switch to DRV/r monotherapy

Switch to LPV/r monotherapy

Switch to LPV/r monotherapy

Phase 3 Treatment-Naïve and Treatment-Experienced

Clinical Gastroenterology and Hepatology

Switch to LPV/r monotherapy

Sequencing cohorts Open-label Design W8 W12 ≥ 18 years

بسم الله الرحمن الرحيم.

Presentation transcript:

CASE 1 54 yo man HIV Generalized Anxiety/OCD VL 15,185 CD4 ranges from Baseline Genotype clear

CASE 1 Severe intermittent diarrhea – Giardiasis, new psychiatric meds Increasing anxiety/OCD CD VL 10,000 – 15,000

CASE 1 Mid-late 2007 CD4… 280, 230, 170 VL 35,000 – 50,000 Fatigue/intermittent diarrhea increasing anxiety/OCD Feels like he is going to die from AIDS

CASE 1 Late 2007 Initiates TDF+FTC/Nevirapine Week 1 Abdo pain with normal liver enzymes Day 14 Fever/maculopapular rash/weakness/flu-like illness ARV’s discontinued

CASE TDF+FTC/Delaviridine as patient concerned about PI related fat changes/potential Efavirenz related anxiety/depression CD4 200 →490 VL <50x5, 133, 117, 189

CASE TDF+FTC/Delaviridine Increasingly incapacitating fatigue Crestor, Zoloft, Clonazepam, Neurontin…discontinued with no improvement in fatigue

CASE TDF+FTC/Delaviridine CD4 250 VL 2521 Adherence was suspect and ARVS discontinued No dramatic improvement in fatigue for the record

CASE 1 GENOTYPE JUN/09

CASE 1 What would you do?

CASE 1 TDF+FTC/RTV/Darunavir/Etravirine CD4 250 →350 VL 98,636…486 (month 1), 232 (month 2), 94 (month 3), 73 (month4), 60 (month 5) 58 What would you do?

CASE 1 TDF+FTC/RTV/Darunavir/Etravirine continued CD4 380 VL <50x3 (last 8/10)

CASE 1…another issue January months post-initiation of TDF/FTC/RTV/Darunavir/Etravirine liver enzymes begin to rise Serology revealed HEP A & B immune

CASE 1 ALTTIMEHEPATITIS SEROLOGY 3623/11/09HepC Ab negative 17512/01/10Work up for secondary liver disease negative 46528/01/10Hep C Ab negative 56418/02/10Hep C Ab negative No New Meds/No illicit drugs

CASE 1 Cause? What would you do?

CASE 1 Urinary Drug Screen done Methamphetamine detected Patient was brought in and the above findings discussed including the concept of a methamphetamine induced hepatitis…importance of abstinence outlined

CASE 1 ALTTIMEHEPATITIS SEROLOGY 3623/11/09HepC Ab negative 17512/01/ /01/10HepC Ab negative 56418/02/10HepC Ab negative /03/10 Do you stop ARVs?

CASE 1 Surprise!...FEB/10…Hep C AB neg HCV RNA 3.35 x10 7 Genotype 3 ARVs continued with weekly monitoring

CASE 1 ALTTIMEHEPATITIS SEROLOGY 3623/11/09HepC Ab negative 17512/01/ /01/10HepC Ab negative 56418/02/10HepC Ab negative /03/ /03/ /03/10 Do you stop ARVs?

CASE 1 ALT began to decline after peaking at 1268 despite continuing ARVs It was felt that CD4 maintenance and HIV viral load suppression was important for hepatitis C self- cure…also no evidence of pre-existing liver disease

CASE 1 Probable Hepatitis C self-cure HCV RNADate 3.35 x /02/ x /03/10 <1507/05/10 <1524/06/10