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Acute HIV Syndrome after Discontinuation of Antiretroviral Therapy in a Patient Treated before Seroconversion

Eric S. Daar, MD; Jiexin Bai, MD; Mary Ann Hausner, MS; Martin Majchrowicz, MPH; Mojgan Tamaddon, BA; and Janis V. Giorgi, PhD
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From Cedars-Sinai Burns and Allen Research Institute and the University of California, Los Angeles, Los Angeles, California. Acknowledgments: The authors thank Stephen Nichols, MD, for technical assistance; Jacqui Pitt, RN, for clinical assistance; Marie Reskusic for figure preparation; and John Ferbas, PhD, for critical review of the manuscript. They also thank the patient, who cooperated with all studies and reviewed the manuscript to assure accuracy of the description of the clinical syndrome. Grant Support: In part by the Universitywide AIDS Research Program California Multicenter AIDS Research Consortium Award and National Institutes of Health grant AI-32883. Requests for Reprints: Eric S. Daar, MD, Division of Infectious Diseases, Cedars-Sinai Medical Center, B217, 8700 Beverly Boulevard, Los Angeles, CA 90048. Current Author Addresses: Drs. Daar and Bai and Ms. Tamaddon: Division of Infectious Diseases, Cedars-Sinai Medical Center, B217, 8700 Beverly Boulevard, Los Angeles, CA 90048.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1998;128(10):827-829. doi:10.7326/0003-4819-128-10-199805150-00005
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Primary HIV infection is associated with high levels of viral replication and the development of HIV-specific immune responses [15]. Treating patients during primary HIV infection is recommended [6], but little is known about the effects of such therapy [79]. We report the results of virologic and immunologic studies in a patient who began receiving antiretroviral therapy during primary HIV infection and chose to discontinue therapy after 6 months.

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Figure 1.
Temporal relation among clinical symptoms, antiretroviral therapy, plasma HIV RNA levels, and CD4+ and CD8+ T-lymphocyte counts in a patient treated during primary HIV infection before HIV-specific antibodies were detectable.

ARS = acute retroviral syndrome; AS = acute syndrome; HAART = highly active antiretroviral therapy; RNA = plasma HIV RNA.

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Figure 2.
Memory cytotoxic T-lymphocyte activity in blood, measured as the percentage of specific lysis at different effector-to-target ratios.Left.Right.

Results while the patient was receiving antiretroviral therapy, 169 days after the onset of the acute retroviral syndrome. Results 2.5 months after therapy was stopped, 268 days after the onset of the acute retroviral syndrome. Gag = targets expressing Gag proteins; Pol = targets expressing Pol proteins; control = targets infected with wild-type vaccinia.

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