Recurrence of the acute HIV syndrome after interruption of antiretroviral therapy in a patient with chronic HIV infection: A case report.

Abstract

BACKGROUND:

Clinical and virologic consequences of temporary interruption of HIV therapy are incompletely understood.

OBJECTIVE:

To describe a febrile illness that was consistent with the acute HIV syndrome and occurred after interruption of antiretroviral therapy.

DESIGN:

Case report.

SETTING:

University clinic.

PATIENT:

HIV-infected man.

MEASUREMENTS:

Plasma viral load, lymphocyte subsets, diagnostic evaluation (including cultures and serologic tests), and analysis of lymph node tissue.

RESULTS:

The patient began antiretroviral therapy 3 months after initial HIV exposure and had sustained viral suppression, except during a brief scheduled treatment interruption. One hundred sixty-nine days after resuming therapy, the patient discontinued it again immediately following an influenza vaccination. Eleven days later, he presented with a febrile mononucleosis-like syndrome associated with dramatic shifts in plasma HIV RNA level (<50 to >1 000 000 copies/mL) and CD4 cell count (0.743 x 10(9) cells/L to 0.086 x 10(9) cells/L). Evaluation for alternative causes of fever was unrevealing. Symptoms resolved rapidly with resumption of HIV therapy.

CONCLUSION:

Therapeutic interruption may be associated with profound viral rebound and recurrence of the acute HIV syndrome.

• Authors: J M Kilby, P A Goepfert, A P Miller, J W Gnann Jr, M Sillers, M S Saag, R P Bucy
• Journal: Annals of internal medicine (Ann Intern Med) Vol. 133 Issue 6 Pg. 435-8 (Sep 19 2000) ISSN: 0003-4819 [Print] United States
• PMID: 10975961 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S., Review)

Chemical References

• Anti-HIV Agents
• HIV Protease Inhibitors
• RNA, Viral
• Reverse Transcriptase Inhibitors
• Lamivudine
• Zidovudine
• Indinavir

Topics

• Acute Disease
• Adult
• Anti-HIV Agents (therapeutic use)
• CD4 Lymphocyte Count
• Chronic Disease
• Disease Progression
• Drug Therapy, Combination
• Fever (virology)
• HIV (genetics)
• HIV Infections (drug therapy, immunology, virology)
• HIV Protease Inhibitors (therapeutic use)
• Humans
• Indinavir (therapeutic use)
• Lamivudine (therapeutic use)
• Male
• RNA, Viral (blood)
• Recurrence
• Reverse Transcriptase Inhibitors (therapeutic use)
• Syndrome
• Viral Load
• Zidovudine (therapeutic use)