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

2. CASE 2
BASELINE GENOTYPE OCT/06

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

4. 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)

5. 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?

6. CASE 2
GENOTYPE OCT/2011

7. CASE 2
WHAT WOULD YOU DO ?

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

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

10. 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?