CASE 2 53 yo man HIV + 2006 CD4 340/16% (Nadir) VL 30,100 c/ml.

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CASE 2 53 yo man HIV + 2006 CD4 340/16% (Nadir) VL 30,100 c/ml

CASE 2 BASELINE GENOTYPE OCT/06

CASE 2 April 2008 Abacavir/3TC/Tenofovir/Ritonavir/ Lopinavir/Raltegravir/Maraviroc initiated as part of intensification study

CASE 2 REGIMEN HIV VIRAL LOAD 04/08 ABC/3TC/TNF/RTV/LPV/RGV/MVC 30,100 DATE REGIMEN HIV VIRAL LOAD 04/08 ABC/3TC/TNF/RTV/LPV/RGV/MVC 30,100 05/08 SAME AS ABOVE <50 01/09 SAME 01/10 01/11 <40 03/11 <0 (ultrasensitive)

CASE 2 March 2011 WHAT HAPPENED? Regimen de-intensified to Truvada/Raltegravir as complex and VL=0 DATE REGIMEN HIV VIRAL LOAD 05/11 TDF/FTC/RGV 194 06/11 SAME AS ABOVE 175 07/11 SAME 361 09/11 244 WHAT HAPPENED?

CASE 2 GENOTYPE OCT/2011

CASE 2 WHAT WOULD YOU DO ?

CASE 2 Sept/2011 Told to stop all therapy x 3 months in order to repopulate with wild-type

CASE 2 Oct/2012-Jan/2012…No therapy CD4 460/17%, 330/17% VL 4851 c/ml, 3069 c/ml

CASE 2 Jan/2012 Would you de-intensify? Reinitiated ABC/3TC/RTV/DRV/ETR/RGV instead of ABC/3TC/TNF/RTV/LOP/RGV/MVC DATE CD4 COUNT HIV VIRAL LOAD 02/12 430/19% <40 03/12 04/12 600/16% 565/20% Would you de-intensify?