Saturday, June 10, 2023
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Head
Department of Infectious Diseases
Hospital Ramón y Cajal
Madrid, Spain
This activity has been peer reviewed and the reviewer has no relevant financial relationships.
This educational activity is intended for an international audience of non-US HIV specialists, primary care physicians, and hematology/oncology specialists.
The goal of this activity is for clinicians to be able to manage patients with difficult-to-treat HIV.
Upon completion of this activity, participants will:
WebMD Global requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships with ineligible companies.
Head
Department of Infectious Diseases
Hospital Ramón y Cajal
Madrid, Spain
This activity has been peer reviewed and the reviewer has no relevant financial relationships.
The Faculty of Pharmaceutical Medicine of the Royal Colleges of Physicians of the United Kingdom (FPM) has reviewed and approved the content of this educational activity and allocated it 1.0 continuing professional development credits (CPD).
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CPD Released: 4/13/2022
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The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.
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The first patient in this case series is a 52-year-old woman who was diagnosed with HIV in December 1999. At diagnosis, her CD4+ count was 62 cells/µL and HIV RNA was 200,000 copies/mL. She had no history of opportunistic infections at diagnosis. Her treatment history and reasons for switch are outlined in Table 1.
|
From |
To |
Regimen |
Reason for Switch |
|---|---|---|---|
|
December 1999 |
February 2001 |
D4T + 3TC + NVP |
Virological failure |
|
February 2001 |
August 2001 |
ZDV/3TC + NVP |
Virological failure |
|
August 2001 |
January 2002 |
ZDV/3TC/ABC |
Virological failure |
|
January 2002 |
January 2004 |
ZDV/3TC/ABC + TDF |
Virological failure |
|
January 2004 |
January 2009 |
TDF/3TC/EFV |
Virological failure |
|
January 2009 |
June 2010 |
DRV + MVC + RAL |
Virological failure |
|
June 2010 |
January 2013 |
ETR + MVC + RAL |
Virological failure |
|
January 2013 |
April 2013 |
No therapy |
Virological failure |
|
April 2013 |
November 2015 |
3TC |
Virological failure |
3TC, lamivudine; ABC, abacavir; D4T, stavudine; DRV, darunavir; EFV, efavirenz; ETR, etravirine; MVC, maraviroc; NVP, nevirapine; RAL, raltegravir; TDF, tenofovir disoproxil fumarate; ZDV, zidovudine.
On referral to the clinic, the patient had a viral load of 50,000 copies/mL and CD4+ count of 167 cells/µL. Her body weight was 61 kg, blood pressure was 120/88 mm Hg, heart rate was 74 beats per minute (bpm), and respiratory rate was 16 respirations per minute (rpm). Kidney and liver function tests were normal, and her fasting blood glucose was 4.5 mmol/L. A physical examination recorded no abnormal findings.
The patient had reported no adverse reactions to any of the drugs in her treatment history except for the development of lipoatrophy following treatment with zidovudine (ZDV) and stavudine (D4T).
