1. CASE 3 52 yo man HIV positive 1999 CD4 nadir 50 Smoker 35 pack yrs…quit 2005 COPD…chronic bronchitis Diabetic, Hypertensive, Hyperlipidemic

2. CASE 3 2006 Abacavir/3TC/RTV/Atazanavir Trial of steroid inhaler for COPD Worsening of hypertension, diabetes and lipids along with a change in body habitus with increased centripetal obesity and a dorsocervical fat pad

3. CASE 3 2010 Development of rapidly growing right sided inguinal mass No constitutional symptoms On examination…rock hard, immobile, 6 cm right inguinal mass

4. CASE 3 2010 In retrospect has ignored very minor painless intermittent painless rectal bleeding over past 4 months CD4 890 HIV viral load<50

5. CASE 3 2010 On further examination….rectal ulceration approx. 3 cm with heaped up edges DIAGNOSIS?

6. CASE 3 2010 CT Scans of chest/abdo/pelvis/revealed inguinal mass and nothing more HOW WOULD YOU FURTHER INVESTIGATE?

7. CASE 3 2010 Ultrasound guided core biopsy revealed…squamous cell ca Biopsy of rectal ulceration…anal squamous cell ca!

8. CASE 3 2010/2011 Chemotherapy, radiation and surgery to remove residual groin mass Thus far free of disease…will need very close f/u over time both clinically and radiographically

9. HIV CASE PRESENTATIONS Mike Silverman MD FRCPC David Fletcher MD FRCPC