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A 47-year-old African-American woman with a history of hypertension and diabetes was diagnosed with HIV infection in 2005. At the time, her CD4 count was 780 cells/mm3, and her viral load was 1200 copies/mL; other notable baseline laboratory results included a serum creatinine level of 3.3 mg/dL and heavy proteinuria on urinalysis. A renal ultrasound demonstrated small kidneys, suggestive of advanced diabetic and hypertensive renal disease, but she was started on antiretroviral therapy (ART) in case there was a component of HIV nephropathy.
The patient was initially placed on AZT + 3TC (both renally dosed) + ritonavir-boosted atazanavir, but the ritonavir was discontinued because of gastrointestinal side effects. For 2 years, her viral load …