1 / 14

Case Discussion: Complications after ART

Case Discussion: Complications after ART. Weerawat Manosuthi, MD Department of Medicine Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, Thailand. Case: SW, 55 year-old male . Case: SW, 55 year-old male . Q1: Do you agree with this regimen “ TDF+3TC+LPV/ r ” ?

seamus
Télécharger la présentation

Case Discussion: Complications after ART

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Case Discussion:Complications after ART Weerawat Manosuthi, MD Department of Medicine Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, Thailand

  2. Case: SW, 55 year-old male

  3. Case: SW, 55 year-old male Q1: Do you agree with this regimen “TDF+3TC+LPV/r” ? I do I do not

  4. Case: SW, 55 year-old male

  5. Case: SW, 55 year-old male Q2: What is the most likely cause of renal impairment? Tenofovir Lopinavir/rtv Anti-TB drugs Diabetes 5. Others

  6. Risk Factors Associated with TDF-Induced Nephrotoxicity Mitochondrial toxicity • Older age • Elevated baseline creatinine • Low body weight • Low CD4 nadir • Other comorbidities: diabetes, HCV • Concomitant use of nephrotoxic drugs • Combined therapy with PI • Inhibition of MRP4 by PI/r leads to increased intracellular tenofovir levels • Genetic factors, involving polymorphisms at cellular transporter gene Interfere tubular cell function Rodrı ́guez-No ́voa S, et al. Clin Infect Dis 2009;48:e108-16. KalyesubulaR, et al. AIDS Research and Treatment 2011. Nelson M, et al. AIDS 2008;22,1374-1376. Zimmermann AE, et al. ClinInfect Dis 2006;42,:283-290. Rodrı ́guez-No ́voa S, et al. Expert Opinion 2012;9:545-559.

  7. Case: SW, 55 year-old male Q3: Which of the following is the best next regimen? PI/r + integraseinhibitor + 3TC PI/r + etravirine+3TC PI/r + integraseinhibitor + Etravirine Others

  8. Case: SW, 55 year-old male Q4: Which of the following is a next regimen if he is in the resource-limited setting (3 classes available) ? PI/r + 3TC PI/r + AZT +3TC Others

  9. Case: SW, 55 year-old male

  10. Case: SW, 55 year-old male Q5: What would you manage this episode of TB?

  11. Case: SW, 55 year-old male

  12. Case: SW, 55 year-old male • Q6: Which of the following is the best next regimen? • PI/r + integrase inhibitor + Etravirine • PI/r + integraseinhibitor +3TC • PI/r + 3TC • Others

  13. Case: SW, 55 year-old male

  14. Thank you

More Related