Here we provide you with cases published in the HIV/TB Drug Resistance & Clinical Management Case Book. These cases have been presented to over 1000 medical doctors in southern Africa at the annual SATuRN Drug Resistance Workshops.
The objective is to capacitate doctors, nurses and allied medical staff at all levels of the health system to prevent and manage HIV and TB drug resistance.
Authors: Theresa Rossouw, Richard Lessells & Tulio de Oliveira
This 38 year old female patient initiated d4T/3TC/EFV in March 2008. Her baseline CD4 cell count was 108 cells/ul and WHO clinical stage 3. She had a past history of pulmonary TB in 2004. She has been documented to have good adherence, although it was noted that her treatment supporter was her 10-year old daughter.
She had a suboptimal initial virological response to ART (VL 1300 copies/ml at six months ) but then exhibited virological suppression at 12 months. Subsequently she had three VL > 5000 copies/ml and a progressive decline in CD4 cell count, despite step-up adherence counselling. Genotypic resistance testing is performed.