VIRTUAL MEDZONE Your Resource for HIV Related Innovative Medical Communication.

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Presentation transcript:

VIRTUAL MEDZONE Your Resource for HIV Related Innovative Medical Communication

CASE PRESENTATIONS Chris Steingart MD FRCPC John MacLeod MD CCFP David Fletcher MD FRCPC

CASE 2 45 y.o. man HIV CD4…10 asymptomatic

CASE Cryptogenic Cirrhosis (biopsy proven) Hepatitis A & B immune/Hepatitis C Ab & HCV RNA (-) Recurrent ascites/UGI bleeds secondary to gastric/esophageal varices

CASE Varices banded & glued Nadolol instituted for secondary prophylaxis of variceal bleeding

CASE No further bleeding or ascites for the past 13 years U/S done q-6 months for hepatoma screening – negative Late 2009 variceal surveillance via OGD reveals very small distal esophageal varices

CASE 2 DATEHIV THERAPYCD4VL 1995AZT/ddI10 → /97AZT/ddI/RTV /00D4T/3TC/IDV

CASE 2 Genotype MARCH 2000

CASE 2 DATEHIV THERAPYCD4VL 2000/01NONE… PT CHOICE 150 → → 203, /05D4T/3TC/LPV/APV/ EFV 50 → 280< NONE 2 o to NSAID related gastritis , /07ABC/3TC/LPV/APV/ EFV 510< /08OD ½ dose ABC/3TC/LPV/APV/ EFV 16097,986

CASE 2 Genotype MARCH 2008

CASE 2 DATEHIV THERAPYCD4VL 2009/10NO MEDS ON/OFF MEDS ABC/3TC/RTV/ DRV/ ETR/RGV x 2mos 200<50

CASE 2 On another note DATECREATU/AA/C RATIO (-)X (-)X (-)X (-) X X160

CASE 2 DATECREATU/AA/C RATIO PROT. RAND SERUM ALBUMIN 02/09107X<2<0.15 g/l 36 x 10yrs 06/10125X160XX 09/ g/l (-) bld/wbcs g/l X 10/10158X184X36

CASE 2 U/S ABDO 10 & 10.9 cm nephrosclerotic kidneys Unchanged in size from 2007 but approximately 1 cm smaller as compared with 2002

CASE 2 No NSAIDS No new meds/holistics/herbals No illicit drugs Normotensive…no ankle swelling GFR (C-G) → 35 ml/min!

CASE 2 WHAT IS GOING ON ?? HOW WOULD YOU MANAGE THIS PATIENT ??

CASE 2 Dosage of ABC/3TC/RTV/ Darunavir/Etravirine/Raltegravir not adjusted Nadolol low dose so kept as is

CASE 2 Hepatitis serology inactive ANA,C3,C4,CH50, ANCA negative SIE/UIE negative BS/HBA1C always normal

CASE 2 Nephrology consulted regarding renal biopsy

CASE PRESENTATIONS Chris Steingart MD FRCPC John Macleod MD CCFP David Fletcher MD FRCPC

VIRTUAL MEDZONE Your Resource for HIV Related Innovative Medical Communication