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

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

3. CASE 3 DATEASTALTALPBili 06/2005621108618 CAUSE(S)?? WHAT NEXT??

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

5. CASE 3 2005… U/S liver 20 cm echogenic liver c/w fatty liver Normal spleen size/no varices

6. CASE 3 2005… Fatty Liver Exercise/Weight loss Cessation of ETOH Treatment of lipids

7. CASE 3 DATEASTALTALPBili 06/2005621108618 06/200654807650 06/200939897239 06/201221687440

8. CASE 3 Fibroscan 12/2013 6.5 kpa CAP 272 dB/m (gd 2/3 fat) Will follow

9. CASE 3 DATECreat.ALB/Creat Ur/Protein U/A 06/2005990.9 - (-) 06/2012990.9 - (-) 02/201310026.7 1.29 3+ blood 1 g/l prot. 03/20138818.4 0.648 “ 05/20139448.2 0.451 “ 09/201396- 1.805 “ ABC/3TC/RTV/ATZ Painless microhematuria

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

11. CASE 3 2013 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

12. CASE 3 DATECreat.ALB/Creat Ur/Protein U/A 06/2005990.9 - (-) 06/2012990.9 - (-) 02/201310026.7 1.29 3+ blood 1 g/l prot. 03/20138818.4 0.648 “ 05/20139448.2 0.451 “ 09/201396- 1.805 “ 11/20139453.3 (>4gm/l) 7.178 3+ blood >3 g/l prot. ABC/3TC/RTV/ATZ CAUSE(S)??

13. CASE 3 DATECreat.ALB/Creat Ur/Protein U/A 06/2012990.9 - (-) 02/201310026.7 1.29 3+ blood 1 g/l prot. 05/20139448.2 0.451 “ 09/201396- 1.805 “ 11/20139453.3 (>4gm/l) 7.178 3+ blood >3 g/l prot. 01/20148867.5 1.875 3+ blood 1 g/l prot. ABC/3TC/RTV/ATZ Role of Renal Biopsy vs waiting??