2019 Ryan White HIV/AIDS Program CLINICAL CONFERENCE

T cell “ activation ” is lower in treated than untreated adults, but consistently higher than “ normal ”

P< 0.001

80

P< 0.001

60

40

% CD38+HLADR+ CD8+ T Cells 0 20

HIV Negative (n=82) I + Untreat d (n=82)

Non- Controller (n=65) HIV + ART (n=65)

HAART (n=132)

HIV – (n=132)

Hunt etal JID 2003,PLoS ONE2011and unpublished

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Question

Should I change a regimen when low level detectable virus is present?

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Case 4 • 55 yo male referred to you for evaluation • Diagnosed 18 years ago with HIV infection • Initial: HIV RNA 936,000c/ml CD4 count 70 cells/ul • Current: HIV RNA 85 c/ml (prior value 62 c/ml) CD4 count 525 cells/ul • Started on NEL/D4T/3TC; subsequently treated with • LOP-r / TDF/FTC, • EFV/ FTC/ TDF (fdc). • Now DTG / DRV/c / 3TC • No historical resistance tests are available

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