Panel of Experts: Resistance Cases

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Panel of Experts Resistance Cases

• All Faculty

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Case Study LJ

• LJ is a 38 year old black female who presents to
  a rural Ryan White-funded clinic for initial
  appointment.
• She tested positive for HIV in February of 2006
  (Patient previously tested negative about 6
  months prior)
• Her PMH is significant for multiple STDs (GC x 2,
  chlamydia)

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Case Study LJ

• Would you perform baseline resistance testing in
  this patient?
• Yes
• No, would perform only after ARVs initiated
• No, funding not available for baseline resistance
  tests in my area

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Case Study LJ
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Mutations Selected by NNRTIs
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Case BC

• 63 y/o AAF HIV infected-1996
• PMH
• T2DM
• hypertension
• depression
• pancreatitis
• ETOH abuse
• Hodgkin lymphoma 8/21/07

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BC ART history

• ART history CD4/VL
• 4/97-8/01 ZDV/3TC/NVP ?

• Resistance test
• Genotype 5/01
• RT 188L, 184V
• Prot WT

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BC ART history

• ART history
  CD4 ()/VL
• 8/01-4/02 DDI/D4T/NFV
  ?
• pancreatitis
• 4/02-1/03 ZDV/3TC/TDF 382
  (19.1)/7881
• 12/02
  398(18.1)/11271

• Genotype 1/03
• RT 188L, 67N, 70R, 215Y
• Prot D30N, 77I, 88D

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BC ART history

• ART history CD4()/VL
• 7/03-8/03 ABC/3TC/LPV
  231 (10.5)/91495
• 11/03 335
  (14.6)/lt75
• 8/03-7/04 no ART
  221 (12.3)/23999

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BC ART history

• ART history
  CD4()/VL
• 7/04-5/06 ZDV/TDF/ATVr 477
  (19.9)/1414
• 12/04
  526 (21.9)/385

• Resistance test
• Genotype 11/05
• RT 188L, 215Y, 219E, 67N, 70R
• PROT 46I, 30N, 46I, 50L, 82A

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BC ART history

• ART history CD4()/VL
• 5/06-9/06 TDF/FTC/LPV 254
  (15.9)/14868
• 7/06 236
  (12.7)/54871
• 9/06-5/08 ABC/3TC/LPV
• 1/07 288
  (13.1)/lt75

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BC ART history

• ART history
  CD4()/VL
• 5/08-6/08 TDF/FTC/DRVr/RTG
• 8/6/08 114(5.7)/

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Thank you!!!!