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					Developing Countries: Loukou




          7th Advanced HIV Course Montpellier 2009
                    Developing Countries
Developing Countries: Loukou
 * A 28 years-old man, not married, no children, homosexual, tested HIV-1
 positive in February 2007;

 * Medical history:
 -Chronic fever, cough, weight loss,


 * Stage B (CDC)

 * Biological parameters at c-ART initiation:
 WBC (2370 /mm3), Neutrophila (1000/mm3), Hb (9,8 g/dl), platelets
 (111000/mm3), CD4 (179/mm3,19%)
 ALT (104 UI/l), AST (72UI/l), Creatinine (8,71 mg/l), Glycemia (0,78 g/l);
 * Complete this screening if necessary




                         7th Advanced HIV Course Montpellier 2009
                                   Developing Countries
Developing Countries: Loukou
* c-ART started 05/11th/2007
  - d4T 30 mg + 3tC150 mg + NVP 200mg (triomune)
* 14 days after ART initiation, fever, icterus, cough
   Stop of triomune by the patient before visiting the hospital
 * chest X-ray: pneumonia, BAAR in the sputum
   - AST 71 UI/ml, ALT 132 UI/ml
   - Antigen HbS negative, Antibodies anti-HbC IgG +, Antigen Hbe
     negative, ADN HVB 204 516 copies/ml
* What is your principal diagnosis?
* Suggest the treatment (s) of this patient in a context
  where rifabutine is no available


                      7th Advanced HIV Course Montpellier 2009
                                Developing Countries
Developing Countries: Loukou
Answers
* Q1) Chest X-ray, HVB tests
* Q2) IRIS, TB and occult hepatitis B
* Q3)
●TB treatment without isoniazid
● c-ART: avoid EFV, ALT> 5N
● Avoid PI with rifampicine
   - TDF + 3TC/FTC + AZT (3 nucs) or
   - TDF + 3TC/FTC + Raltegravir




                      7th Advanced HIV Course Montpellier 2009
                                Developing Countries
Developing Countries: Loukou
Lessons learned
- prevalence of IRIS in TB and HBV endemic aera

-     issues of HBV/HIV co-infection in west and central Africa where HBV is
      more prevalent than HIV

-     Issues of occults hepatitis B in RLS, difficulties of HVB diagnosis, viral
      load HBV not available;

     needs of alternative tests cheaper and accurate (real-time PCR)

- Use and availability of NRTI for HIV and HBV

- Issues of c-ART with TB treatment containing rifampicine when

    EFV cannot be used


                             7th Advanced HIV Course Montpellier 2009
                                       Developing Countries

				
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