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

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

3. CASE 1 46 y.o. man HIV + 2006 CD4 290 HIV VL 59,246 HLAB5701 positive

4. CASE 1 BASELINE GENOTYPE

5. CASE 1 WHAT WOULD YOU TREAT WITH?

6. CASE 1 2007 TDF+FTC/Lopinavir/RTV initiated CD4 290 increased to 400 HIV VL <50

7. CASE 1 2007-2008 TDF+FTC/Lopinavir/RTV GI Intolerance Triglycerides 11.5 mmol/l despite optimal management Cholesterol 8 mmol/l … LDL ? Previously normal lipids WHAT WOULD YOU DO?

8. CASE 1 2008 TDF+FTC/RTV/Atazanavir Jaundice Lipids remain abnormal and unchanged!!! WHAT WOULD YOU DO?

9. CASE 1 2009 TDF+FTC/RTV/Darunavir Lipids remain abnormal  ’d albumin/creatinine ratio to 90 (N<2) 24 hr urine 2.534 g/day (N<250 mg) 24 hr creatinine clearance 60 ml/min (N>97 ml/min) WHATS GOING ON? WHAT WOULD YOU DO?

10. CASE 1 2009/10 Tropism R5 3TC/Etravirine/Maraviroc/Raltegravir CD4 540-610 HIV VL <50 x 3 Cholesterol 3.83 mmol/l LDL 1.68 mmol/l

11. CASE 1 2009/10 3TC/Etravirine/Maraviroc/Raltegravir Albumin/creatinine ratio… 1 24 hr urine protein…150mg/day 24 hr creatinine clearance… 96 ml/min