Images of Infectious Diseases
“Food gets stuck in my Adam’s apple”
A 68 year old man presents with weight loss and dysphagia for 6 weeks. Upper endoscopy is shown. What is your diagnosis? #MayoIDQ and case details to follow
“Food gets stuck in my Adam’s apple”
A 68 year old man presents with weight loss and dysphagia for 6 weeks. Upper endoscopy is shown. What is your diagnosis? #MayoIDQ and case details to follow
2/
68M. No PMH. 6w gradual dysphagia to solids with 20 lb weight loss. No F/C/sweats. PE: cachexia. WBC 4.7 Cr 0.9 CXR normal. HBV(-). Rx fluconazole.
Per your suggestion: HIV VL 56K CD4 26. Patient willing to start ART immediately. Genotype pending. You suggest which one?
68M. No PMH. 6w gradual dysphagia to solids with 20 lb weight loss. No F/C/sweats. PE: cachexia. WBC 4.7 Cr 0.9 CXR normal. HBV(-). Rx fluconazole.
Per your suggestion: HIV VL 56K CD4 26. Patient willing to start ART immediately. Genotype pending. You suggest which one?
3/
Case diagnosis: Esophageal candidiasis in a man with newly diagnosed AIDS
Suggested ART: TAF-FTC-bictegravir
ART consists of 2 NRTI in combo with 3rd drug: INSTI, NNRTI or boosted PI.
Among them: INSTI is preferred for various reasons (next)
Case diagnosis: Esophageal candidiasis in a man with newly diagnosed AIDS
Suggested ART: TAF-FTC-bictegravir
ART consists of 2 NRTI in combo with 3rd drug: INSTI, NNRTI or boosted PI.
Among them: INSTI is preferred for various reasons (next)
4/
ART should be individualized based on virologic efficacy, potential adverse effects, childbearing potential and use of effective contraception, pill burden, dosing frequency, drug-drug interaction potential, comorbid conditions, cost, access, and resistance test results.
ART should be individualized based on virologic efficacy, potential adverse effects, childbearing potential and use of effective contraception, pill burden, dosing frequency, drug-drug interaction potential, comorbid conditions, cost, access, and resistance test results.
5/
Among INSTI: dolutegravir or bictegravir preferred
Raltegravir has lower barrier to resistance than dolutegravir or bictegravir, it is not part of any single-tablet regimen, and have a higher pill burden than those containing dolutegravir or bictegravir.
Among INSTI: dolutegravir or bictegravir preferred
Raltegravir has lower barrier to resistance than dolutegravir or bictegravir, it is not part of any single-tablet regimen, and have a higher pill burden than those containing dolutegravir or bictegravir.
/6
Recommended Initial Regimens for Most People with HIV:
* Bictegravir/TAF/FTC
* Dolutegravir/ABC/3TC—for individuals who are HLA-B*5701 negative and without HBV
* Dolutegravir plus (FTC or 3TC) plus (TAF or TDF)
* Dolutegravir/3TC (selected patients)
Recommended Initial Regimens for Most People with HIV:
* Bictegravir/TAF/FTC
* Dolutegravir/ABC/3TC—for individuals who are HLA-B*5701 negative and without HBV
* Dolutegravir plus (FTC or 3TC) plus (TAF or TDF)
* Dolutegravir/3TC (selected patients)
• • •
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