HIVAIDSAnn M. Khalsa, MD, MSEd, AAHIVSMcDowell (HIV/AIDS) Healthcare Center, MIHSArizona AIDS Education and Training CenterPhoenix, Arizona, USA*

Anneliese H.

Teri A.CHDC*

Anneliese 42 HIV+ 2002:3 2 2007 :60: *

Anneliese 3/2009: 2: 15 PE: BMI 27, 91cm, 110/70*

2002-20073/2009 CD4 # / %500s82 / 6%HIV-1 RNAARV122,000ARVTDF-FTC-ATVrARVARV1.5, EFVCreat 0.81, Ur Prot negTC 141 / TGA 758 / HDL 26Gluc 253 / HgbA1c 9.6

Anneliese ?# 1HIV

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Anneliese ?# 11)HIV2)3)4)5)Check all that apply

Anneliese ?# 1 HIVPotential immediate complications

*

Anneliese ST 800/160mg 11 500mg 12 600mg 12 400 mg 12(discount pharmacy program)

HIV*

Anneliese ?# 22301

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Anneliese ?# 22 3014) 3)2)1)--- Choose all that apply ---

Anneliese ?# 2 850mg *

Anneliese ?# 2 Am.Assoc.Clin.Endocrin. , Endocrine Practice 2007, 13:3-68;Am.Diab.Assoc., Diabetes Care 2010, 34:S11-S61.*

Hgb A1c6-7, TZD, , 7-828-10>10

Anneliese ?# 2 *

/ NASH, TGA, LDL TGA, HDL

Anneliese ?# 2 :(1%)

*

- - - < 30% < 10% < 300 mg/d25-35% < 7% (LDL) < 200 md/d25-50 g/d 10-25 g/d /50-60%/ - 500-1000 - 5-7%

Anneliese ?# 320097 ART 2-NRTI3HIV?----*

Anneliese ?# 320097 ART 2-NRTI3HIV?5)-4)-3)2)-1)-

Anneliese ?# 33HIV:----*

Anneliese *

3/20095/20097/20098/20091/2010CD4 #82 / 6%--71/10%116/12%HIV-1 RNA122,000--212

Anneliese ?# 4

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Anneliese ?# 4--- check all that apply ---5)4)3)2)1)

Anneliese ?# 4 ---

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Anneliese ?#4 TG:: HIV: : - TG:: 3: : *

Anneliese 10 *

3/20097/20091/201012/2010CD4 #82 / 6%116/12%24/5%HIV-1 RNA122,000

Anneliese ?# 5 ARVARVARV ARV *

Anneliese ?# 5 ARV4)ARV 3)ARV 2)1)ARV

Anneliese ?# 5 ARVARVARV ARV *

Anneliese H *

3/20097/20091/201012/20103/2011CD4 #82 / 6%116/12%24/5%37/7%HIV-1 RNA122,000

Anneliese ?# 6HIV *

5)4)3) 2)Anneliese ?# 6HIV1)

Anneliese ?# 6 HgbA1c >10 *

Anneliese ?#6 (HgbA1c >10):(Lantus, Levemir or NPH) ------ (Aspart, Lispro, Glulisoline)*

Aspart (NovoLog) Lispro (Humalog) Glulisine (Apidra)5-15m30-90m

Anneliese ?#6 : ( ):Glinides+ - -Glucosidase - ; inhibitors-Sitagliptan+ - ():Exenatide+ , Pramlinitide+ , -

*

Anneliese H *

3/20097/20091/201012/20103/20116/2011CD4 #82 / 6%116/12%24/5%37/7%58/8%HIV-1 RNA122,000

Anneliese H.

Teri A.CHDC

*

Teri A 5320108HIV+ HCV+ 2000HIV- HCVHCV : (2002-2009) HIV*

Teri A 20104 : 2002 20101 STDs , 6 1() 23: 1984-2002 1995-2003 : 1130 : 60 *

Teri A 20108 : TST (HR=50)-I : *

Time (hr):1 hr5 hrs8 hrs18 hs21 hrs(NL

Teri A , , integrilin , , : 40% 50% :*

Teri A :-

*

Teri ?#1HIV --ACE 3*

HIV 6) 35)4)3)ACE 2)-1)- Teri ?#1

Teri ?#1 HIV -:-:CVDACE : , CVD::, LDL 3: , HDL*

Teri ?#1 :- 50-60ACE 20-30% 181-325 mg1 LDL 40 , 15-20%

*

Teri ::25 mg 12 81 mg 11 2.5 mg 113 1000 mg 12HCVHCV*

Teri ARV ?#2HCV HIV*

Teri ARV ?#2HCV HIV6)5)4)3)2)1)

Teri ARV ?#2 HCV HIVHCV & *

Teri : HLA B*5701 ARV: 201010 3TC-ETV-RAL *

9/23/201011/4/20103/10/2011350043005200120019002400CD4 T 257345426CD4 % T 212223CD4/CD8 0.30.30.4HIV-1 RNA 11813 (H)

Teri HCV ?#3C 1HCVHCV*

Teri HCV ?#3C 4)HCV3)2)HCV1

Teri HCV ?#3 C1 HCVHCV*

Teri HCV ?#4HCV HCV HCV RNA*

Teri HCV ?#4HCV 5)4)3)HCV RNA2)HCV 1)

Teri HCV ?#4 HCV

HCV HCV RNA: GT 1RNA*

Teri A HCV 201012:1.5 cm SOL (7.7cm vs 12.4 cm / )20111CT :, 20113: , Stage 2-3 *

Teri HCV ?#4 53 NoBMI23Yes3aYesHCV RNA 2,186,720 NoNo/Yes93YesCD4ARV=426 YesHIV RNAARV=

Teri ARV HIV :3TC-ETV-RAL 10/2010HCV: RBV-PegIFN2a 5/2/2011*

9/23/201011/4/20103/10/20116/6/20118/31/2011CD4 T 257345426348250CD4 % T 2122233146CD4/CD8 0.30.30.40.61.1HIV-1 RNA 11813 (H)

Adapted from EACS Guidelines October 2011http://www.europeanaidsclinicalsociety.org/*

DiseaseAssessmentFollow-Up FrequencyCommentsCVDRisk assessmentFramingham scoreEKGConditionalConsider prior to PI with potential conduction problemsHTNBlood pressureAnnualLipidsTC, HDL, LDL, TGAnnualRepeat fasting prior to medical interventionDiabetesFasting plasma glucose6-12 mHgbA1c or oral GTTConditionalif fasting glucose > 100-125 mg/dl (5.7-6.9 mmol/L)RenalRisk assessmentAnnualCKD, DM, HTN, CVD, HCV, medications, family historyeGFR3-12 mMore often if: CKD or risk factors present; or if on nephrotoxic drugs (ARV: TDF, IDV, ATV; OI: ganciclovir, amphoterocin; etc.)Urine dipstick: protein, blood6-12 mEvery 6 mo if eGFR

- *

DiseaseAssessmentFollow-Up FrequencyCommentsLiverRisk assessmentAnnualMore frequent on hepatotoxic drugsALT/AST, AlkPhos, Bilirubin3-12 mNeuroCogScreening questions2 yrsRule out confounding conditionsDepressionScreening questions1-2 yrsMore frequent in at-risk patientsCancerMammography1-3 yrsW: 50-70 yrs or W/M: high risk historyCervical PapColposcopy1-3 yrsW: Sexually activeFor ASCUS PapDRE and Anal Pap

Anoscopy1-3 yrsMSM: evidence preliminaryM/W: high risk (HPV dis or RAI)For ASCUS PapUltrasound and AFP6 moPatients with cirrhosis from any causeDRE PSA1-3 yrsM >50, or high riskFOBT or Colonoscopy1-3 yrs 5-10 yrs50-75 yrs, or high risk

*****HIVCD42PCP3

5HIV

*

-1SU2-DPP-4GLP-1

http://dm-rg.net/

-2CI-7192002.12.16**2,250mgII

4

**

*HIV

**ATV

RALDr KhalsaRALBID

*

**SURVEY123511002710040140*Dr Khalsa33

3DHAEPAEPATG

Dr KhalsaACTG5186333,000BIDTG50%30%3

ARTDr KhalsaTGARTTGART*

**HIVDr Khalsa

Dr KhalsaART

Dr Khalsa1

*Dr KhlasaTG

200932010112LDL

Dr KhalsaLDLTG

TG4-500LDL7-800

*

*--GI322-3

SU

*20001525HIV

102030303530130RRR2430121824NNNN1524253050304050

http://dm-rg.net/1/img/table_insulin/insulinchart.pdf*Dr Khalsa

DPP4GLP-1

8Glinides-Glucosidase inhibitors-SitagliptanDDP-4ExentatideGLP-1Pramlinitide

*

*********Dr KhalsaACE20-30%230%

ACE-IARB

Dr Khalsa312RCT30%CKB

*ACE-I

Dr KhalsaHCV

**ABCDADFDADr KhalsaABCTDFABC

ABCHCVDr KhalsaABCHCV

EFVIFNDr Khalsa

HCVCKDTDF

*3TC+ETV+RALABCTDFDr KhalsaABC/3TC+RALETVTDFDr KhalsaNRTI

AZTABCTDFNRTI

ABCABC

*******HCVPIPeg-INF+RBV70RBVHIVHIVHIVRALATVEFV

Dr KhalsaHCVHIV*HIVEACS201110WEB

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