CASE 3 43 yo man HIV+ since 2005 CD4 nadir 190 Baseline genotype…clear.

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Presentation transcript:

CASE 3 43 yo man HIV+ since 2005 CD4 nadir 190 Baseline genotype…clear

CASE 3 07/2005 ABC/3TC/RTV/ATZ initiated without problems CD4 increased to 720 HIV viral load <50, 40

CASE 3 DATEASTALTALPBili 06/ CAUSE(S)?? WHAT NEXT??

CASE 3 Hep A & B immune Hep C (-) Secondary liver disease workup (-) No illicit drugs ++Etoh consumption BMI 33 Hyperlipidemia

CASE … U/S liver 20 cm echogenic liver c/w fatty liver Normal spleen size/no varices

CASE … Fatty Liver Exercise/Weight loss Cessation of ETOH Treatment of lipids

CASE 3 DATEASTALTALPBili 06/ / / /

CASE 3 Fibroscan 12/ kpa CAP 272 dB/m (gd 2/3 fat) Will follow

CASE 3 DATECreat.ALB/Creat Ur/Protein U/A 06/ (-) 06/ (-) 02/ blood 1 g/l prot. 03/ “ 05/ “ 09/ “ ABC/3TC/RTV/ATZ Painless microhematuria

CASE 3 U/S kidney Normal size kidneys Normal echotexture No stones No obstruction

CASE Inflammatory monoarthropathy of left ankle No diagnosis, but felt to be crystal induced disease Significantly increased NSAID use, more chronically (high dose daily) in fall 2013

CASE 3 DATECreat.ALB/Creat Ur/Protein U/A 06/ (-) 06/ (-) 02/ blood 1 g/l prot. 03/ “ 05/ “ 09/ “ 11/ (>4gm/l) blood >3 g/l prot. ABC/3TC/RTV/ATZ CAUSE(S)??

CASE 3 DATECreat.ALB/Creat Ur/Protein U/A 06/ (-) 02/ blood 1 g/l prot. 05/ “ 09/ “ 11/ (>4gm/l) blood >3 g/l prot. 01/ blood 1 g/l prot. ABC/3TC/RTV/ATZ Role of Renal Biopsy vs waiting??