1. CASE 4 53 yo man HIV+ since 1989 CD4 nadir 220

2. CASE 4 DATEREGIMENCREATININE 1990AZT100 1994AZT/DDI99 1998AZT/3TC/IDV108 1999AZT/3TC/NFV95 2004TDF/AZT/3TC/NFV102 2009TDF/AZT/3TC/RTV/LPVr108

3. CASE 4 Longstanding chronic active (E ag Positive) Hepatitis B/Cirrhosis 3TC resistant

4. CASE 4 DATEARV REGIMEN Creat.ALB/CreatU/A Random Ur. Protein 2004-2010 TDF/AZT/3TC/R TV/LPVr 108-(-)- 2010“1117.4(-)- 02/2011“119-Tr. Protein- 11/2011“14914Tr. Protein- No obvious reversible inciting cause

5. CASE 4 DATECreat.ALB/CreatU/AR. U. Protein 11/201114914Tr. Protein- 02/2012124<2-<0.04 Switched to ABC/3TC/AZT/RTV/LPV in 12/11  AST/ALT +  HBV DNA !!!!!

6. CASE 4 DATECreat.ALB/CreatU/AR. U. Protein 04/201294<2-<0.04 05/2012113--- 06/201210812.4>1g/L1.054 07/201213810.40.3 g/L- Restarted TDF/3TC/AZT/RTV/LPV post 04/12 labs

7. CASE 4 DATECreat.ALB/CreatU/AR. U. Protein 07/201213810.40.3 g/L- 08/201214510.60.3 g/L0.523 09/20121194.60.3 g/L0.998 TDF DOSED TO EVERY OTHER DAY AND RTV/LPV SWITCHED TO RTV/DRV in 7/12 Normal liver enzymes HBVDNA (-)

8. CASE 4 DATECreat.ALB/CreatU/AR. U. Protein 08/201214510.60.3 g/L0.523 09/20121194.60.3 g/L0.998 10/20121224.90.3 g/L0.512 12/20121194.6-- 03/20131043.20.3 g/L0.525 10/20131082.80.3 g/L0.589 SWITCHED TO AZT/3TC/ETR/RGV/TDF eod 10/12 NORMAL LIVER ENZYMES HBV DNA (-)