Academy Exchange

Hi everyone! I am caring for a 73yo male who was diagnosed with HIV in 1992, AIDS dx in 1994. I have good records on him since 2014, very spotty records before that. I know that 2008-2013 he was taking FTC/TDF+ATV/r, and then had an episode of renal lithiasis that caused ARF and his GFR never fully recovered, but has stayed in the 30-40 range since then. At this time he was switched to his current regimen of FTC 200mg QOD, ATV/r QD and AZT 300mg BID. I would love to get him switched to a STR with a higher barrier to resistance, or even just 2 pills QD would be easier. His only other medications are losartan and atorvastatin. 

I don't know his initial VL but the first I can find from 2008 was 45700, CD4 nadir was 140, now hovers around 500. He has been virally suppressed since 2009, and genotype at this time showed no NRTI resistance predicted. Stanford mutation database results attached but widespread NNRTI and PI resistance predicted. According to the genotype, the ATV/r shouldn't be working, but it is. I'm thinking he would be a good candidate for DTG/3TC. Your thoughts? Is there anything else I should think of? 

Thanks in advance for your input,

Deb

Hi everyone! I am caring for a 73yo male who was diagnosed with HIV in 1992, AIDS dx in 1994. I have good records on him since 2014, very spotty records before that. I know that 2008-2013 he was taking FTC/TDF+ATV/r, and then had an episode of renal lithiasis that caused ARF and his GFR never fully recovered, but has stayed in the 30-40 range since then. At this time he was switched to his current regimen of FTC 200mg QOD, ATV/r QD and AZT 300mg BID. I would love to get him switched to a STR with a higher barrier to resistance, or even just 2 pills QD would be easier. His only other medications are losartan and atorvastatin. 

I don't know his initial VL but the first I can find from 2008 was 45700, CD4 nadir was 140, now hovers around 500. He has been virally suppressed since 2009, and genotype at this time showed no NRTI resistance predicted. Stanford mutation database results attached but widespread NNRTI and PI resistance predicted. According to the genotype, the ATV/r shouldn't be working, but it is. I'm thinking he would be a good candidate for DTG/3TC. Your thoughts? Is there anything else I should think of? 

Thanks in advance for your input,

Deb

Hi everyone! I am caring for a 73yo male who was diagnosed with HIV in 1992, AIDS dx in 1994. I have good records on him since 2014, very spotty records before that. I know that 2008-2013 he was taking FTC/TDF+ATV/r, and then had an episode of renal lithiasis that caused ARF and his GFR never fully recovered, but has stayed in the 30-40 range since then. At this time he was switched to his current regimen of FTC 200mg QOD, ATV/r QD and AZT 300mg BID. I would love to get him switched to a STR with a higher barrier to resistance, or even just 2 pills QD would be easier. His only other medications are losartan and atorvastatin. 

I don't know his initial VL but the first I can find from 2008 was 45700, CD4 nadir was 140, now hovers around 500. He has been virally suppressed since 2009, and genotype at this time showed no NRTI resistance predicted. Stanford mutation database results attached but widespread NNRTI and PI resistance predicted. According to the genotype, the ATV/r shouldn't be working, but it is. I'm thinking he would be a good candidate for DTG/3TC. Your thoughts? Is there anything else I should think of? 

Thanks in advance for your input,

Deb