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Case 4: 65-year-old Man Newly Diagnosed, Has Other Health Issues. Paul E. Sax, MD. Clinical Director, Division of Infectious Diseases Brigham and Women’s Hospital Professor of Medicine Harvard Medical School Boston, MA. 65-year-old Man Newly Diagnosed, Has Other Health Issues. - PowerPoint PPT Presentation
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Case 4: 65-year-old Man Newly Diagnosed, Has Other Health Issues
Paul E. Sax, MDClinical Director, Division of Infectious DiseasesBrigham and Women’s HospitalProfessor of MedicineHarvard Medical SchoolBoston, MA
65-year-old Man Newly Diagnosed, Has Other Health Issues
• 65-year-old man is newly diagnosed with HIV infection• Celebrated retirement with prolonged trip to Brazil• During the trip, he had multiple episodes of unprotected sex with
both men and women • After a lengthy "flu" (3 months ago) that in hindsight was likely
acute HIV infection, he is found to be HIV-antibody positive
65-year-old Man Newly Diagnosed, Has Other Health Issues
Physical exam:• BP = 160/110• Otherwise normal• CD4 cell count = 310• HIV RNA = 144,000• Genotype shows no resistancePast medical history:• Notable for difficult-to-control hypertension requiring amlodipine, lisinopril, and
metoprolol• Diabetes, treated with glipizide and metformin• Other medications include simvastatin and sildenafil• Renal function is normal, and he has no proteinuria
65-year-old Man Newly Diagnosed, Has Other Health Issues
Would you start ART now or wait another 2 to 3 months since HIV has been acquired recently and perhaps he has not reached his “set point”?1. Start now2. Wait 2-3 months3. Wait longer
65-year-old Man Newly Diagnosed, Has Other Health Issues
Question to consider:What is the optimal initial regimen in a patient with several cardiovascular and renal risk factors?