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Case Discussions Complications of HIV
Professor Alan Winston
- St. Mary’s Hospital London
Case Discussions Complications of HIV Professor Alan Winston St. - - PowerPoint PPT Presentation
Case Discussions Complications of HIV Professor Alan Winston St. - - PowerPoint PPT Presentation
Case Discussions Complications of HIV Professor Alan Winston St. Marys Hospital London October 2016 Alan Winston Disclosure Alan Winston has received honoraria or research grants from or been a consultant or investigator in clinical trials
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Case Study (2006)
Life long AR
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Case Study (2006)
Life long AR
55‐year‐old Black African gentleman 2006 (10 years ago) Presented with CAP Nadir CD4+ count 80 cells/uL Commenced on an efavirenz containing regimen Suppressed virologically
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Case Study (2008)
Life long AR
55‐year‐old Black African gentleman 2006 (10 years ago) Presented with CAP Nadir CD4+ count 80 cells/uL Commenced on an efavirenz containing regimen Suppressed virologically 2008 Doing well on cART Fall with # wrist
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Case Study (2008) – medical workup
Life long AR Life long AR
Cardiovascular risk factors Controlled hypertension (on amlodipine) Mild hyperlipidaemia DXA scan Lumbar spine: Z‐score: ‐3.2 T‐score: ‐3.3
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Question 1
Low bone mineral density in HIV‐disease is predominantly related to:
1 Traditional risk factors 2 HIV‐disease itself 3 Antiretroviral therapy 4 Combinations of the above
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Considerations
J Infect Dis. 2015 Feb 15;211(4):539‐48
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Considerations
J Infect Dis. 2015 Feb 15;211(4):539‐48
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Management considerations
Prevention and drug therapy
- Assess risk
- General
- reduce risk of falls
- exercise (weight‐bearing, muscle strength, balance training)
- vitamin D replacement
- calcium supplementation
- Bisphosphonate therapy
- Switch ART
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Management considerations
Güerri‐Fernandez et al. J Bone Miner Res 2013
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Case Study (2016)
Life long AR
10 years later Patient on Atripla™ (TDF, FTC, efavirenz) Bone DXA follow up scanning some improvement (had bisphosphonates and on vitamin D replacement) Hypertension remains controlled Lipids now very high (tried a statin and didn’t like it) 10 year Q‐risk is over 20% Non smoker Medication history ART Amlodipine Bone management therapy
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Question 2
What would you do?
1 Dietary and lifestyle advice 2 Try a different statin 3 Change antiretroviral therapy 4 Combinations of the above
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Management considerations – switching ART
Mills AM et al. HIV Clinical Trials 2013;14(5):216–223
EFV/FTC/TDF to RPV/FTC/TDF switch study
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EACS guidelines
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