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Innovative Case Study: Managing a 45-Year-Old HIV+ Patient with Cryptogenic Cirrhosis

This case presentation showcases the ongoing management of a 45-year-old man diagnosed with HIV in 1995, presenting with cryptogenic cirrhosis and recurrent ascites. Initial treatments, including variceal banding and the use of Nadolol for secondary prophylaxis, proved effective. After 13 years without significant complications, the patient continues to undergo regular surveillance for hepatoma and remains stable, with a notable decline in kidney function over the years. This case raises important questions about patient management and treatment adjustments in complex scenarios.

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Innovative Case Study: Managing a 45-Year-Old HIV+ Patient with Cryptogenic Cirrhosis

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  1. VIRTUAL MEDZONE Your Resource for HIV Related Innovative Medical Communication

  2. CASE PRESENTATIONS Chris Steingart MD FRCPC John MacLeod MD CCFP David Fletcher MD FRCPC

  3. CASE 2 45 y.o. man HIV+ 1995 CD4…10 asymptomatic

  4. CASE 2 1996 Cryptogenic Cirrhosis (biopsy proven) Hepatitis A & B immune/Hepatitis C Ab & HCV RNA (-) Recurrent ascites/UGI bleeds secondary to gastric/esophageal varices

  5. CASE 2 1996-97 Varices banded & glued Nadolol instituted for secondary prophylaxis of variceal bleeding

  6. CASE 2 2010 No further bleeding or ascites for the past 13 years U/S done q-6 months for hepatoma screening – negative Late 2009 variceal surveillance via OGD reveals very small distal esophageal varices

  7. CASE 2

  8. CASE 2 Genotype MARCH 2000

  9. CASE 2

  10. CASE 2 Genotype MARCH 2008

  11. CASE 2

  12. CASE 2 • On another note

  13. CASE 2

  14. CASE 2 U/S ABDO 10 & 10.9 cm nephrosclerotic kidneys Unchanged in size from 2007 but approximately 1 cm smaller as compared with 2002

  15. CASE 2 • No NSAIDS • No new meds/holistics/herbals • No illicit drugs • Normotensive…no ankle swelling • GFR (C-G) → 35 ml/min!

  16. CASE 2 WHAT IS GOING ON ?? HOW WOULD YOU MANAGE THIS PATIENT ??

  17. CASE 2 • Dosage of ABC/3TC/RTV/ Darunavir/Etravirine/Raltegravirnot adjusted • Nadolol low dose so kept as is

  18. CASE 2 • Hepatitis serology inactive • ANA,C3,C4,CH50, ANCA negative • SIE/UIE negative • BS/HBA1C always normal

  19. CASE 2 • Nephrology consulted regarding renal biopsy

  20. CASE PRESENTATIONS Chris Steingart MD FRCPC John Macleod MD CCFP David Fletcher MD FRCPC

  21. VIRTUAL MEDZONE Your Resource for HIV Related Innovative Medical Communication

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