1. David Fletcher MD FRCPC Benny Chang MD CCFP Fred Crouzat MD CCFP
CASE PRESENTATIONS
David Fletcher MD FRCPC
Benny Chang MD CCFP
Fred Crouzat MD CCFP

2. CASE 1
64 yo man
HIV+ 1992
CD4 on diagnosis…40
Asymptomatic

3. CASE 1 ARV HISTORY REGIMEN IMMUNOLOGY VIROLOGY TIME AZT 40 →180
AZT/ddI
200 → 400
AZT/3TC
200
AZT/3TC/SQV
200 → 500
9756

4. CASE 1 ARV HISTORY REGIMEN IMMUNOLOGY VIROLOGY TIME D4T/3TC/IDV
550 →950
<500, 56, 60, 131
D4T/3TC/LPV
600 → 1000
<50
TDF/3TC/LPV
2004
ABC+3TC/RTV/ATZ

5. CASE 1 July/09 Syphilis…treated
Aug/09… drug holiday - ran out of meds while on vacation

6. CASE 1
Upon return in Sept/09… CD and VL 2668 off meds

7. CASE 1
GENOTYPE SEPT/09

8. CASE 1 Reinitiation of ABC+3TC/RTV/Atazanavir 09/09 -01/10
VL 2668 → 567, 627, 601
CD → 650

9. CASE 1
GENOTYPE JAN/10

10. CASE 1
ABC+3TC+AZT 01/10 – 3/10
VL CD (unchanged from previous RTV/ATZ regime)
RTV/Darunavir/Raltegravir/Etravirine 3/10-7/10

11. CASE 1 RTV/Darunavir/Raltegravir/Etravirine
VL 695 → 373 (4/10), 386(5/10), 362(6/10), 267 (7/10)
CD → 670
Asymptomatic syphilis in 06/10

12. CASE 1 Why?... What do you do next?
RTV/Darunavir/Raltegravir/Etravirine (7/10)
VL 267
CD4 540
Why?...
What do you do next?

13. CASE 1
Genotype Tropism Testing…R5
Integrase Resistance Pending

14. CASE 1
Patient is currently off HIV medications…What do you restart?