Managing Multiple Diseases: Renal Dysfunction Cases

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Managing Multiple DiseasesRenal Dysfunction
Cases

• Todd S. Wills, MD
• Assistant Professor of Internal Medicine
• Division of Infectious Diseases and International
  Medicine
• University of South Florida College of Medicine

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Disclosure of Financial Relationships

• This speaker has no significant financial
  relationships with commercial entities to
  disclose.

This slide set has been peer-reviewed to ensure
that there are no conflicts of interest
represented in the presentation.
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• 39 year old male presents for initiation of
  antiretroviral therapy
• History of IV drug use
• PMH HTN, hyperlipidemia, depression, anxiety,
  HCV Ab
• CD4 130 cell/mm3
• Viral Load 75,000 copies/ mL
• CBC normal, BUN 14, Cr 0.9 mg/dL

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• Which of the following antiretroviral regimens is
  the best choice for this patient?
• A.) D4T/3TC/Lopinavir-ritonavir
• B.) D4T/ABC/Efavirenz
• C.) Emtricitabine/tenofovir/atazanavir
• D.) Emtricitabine/tenofovir/atazanavir/ritonavir

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• A.) D4T/3TC/Lopinavir-ritonavir
• B.) AZT/ABC/Efavirenz
• C.) Emtricitabine/tenofovir/atazanavir
• D.) Emtricitabine/tenofovir/atazanavir/ritonavir

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• At 6 month follow-up, he is 100 adherent with
  prescribed therapy
• Laboratory Evaluation
• CD4 220 cell/mm3
• Viral load lt 50 copies/ mL
• BUN 26, Cr 2.1mg/dL, PO4 1.8 mg/dL

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• Which drug is not implicated in his renal
  insufficiency?
• A.) Tenofovir
• B.) Emtricitabine
• C.) Atazanavir
• D.) Ritonavir

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• A.) Tenofovir
• B.) Emtricitabine
• C.) Atazanavir
• D.) Ritonavir

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• What percentage of patients taking tenofovir
  suffer severe renal impairment (GFR lt 30 mL/min)?
• A.) 0-3
• B.) 5-10
• C.) 20
• D.) gt30

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• A.) 0-3
• B.) 5-10
• C.) 20
• D.) gt30

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• What percentage of patients taking tenofovir
  suffer mild renal impairment (GFR 60-89 mL/min)?
• A.) 0-3
• B.) 5-10
• C.) 20
• D.) gt30

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• A.) 0-3
• B.) 5-10
• C.) 20
• D.) gt30

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• The patient is changed to 3TC, Abacavir, and
  boosted atazanavir. Is dose adjustment
  necessary?
• A.) Yes
• B.) No
• C.) Need More Information

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• A.) Yes
• B.) No
• C.) Need More Information

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• The patient is 130 lbs. Based on his serum
  creatinine, his calculated creatinine clearance
  is 39 mL/ minute. Which antiretroviral should be
  adjusted?
• A.) Abacavir
• B.) 3TC
• C.) Atazanavir
• D.) Ritonavir

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• A.) Abacavir
• B.) 3TC
• C.) Atazanavir
• D.) Ritonavir