0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Brief Communications |

Recurrence of the Acute HIV Syndrome after Interruption of Antiretroviral Therapy in a Patient with Chronic HIV Infection: A Case Report

J. Michael Kilby, MD; Paul A. Goepfert, MD; Andrew P. Miller, MD; John W. Gnann Jr., MD; Michael Sillers, MD; Michael S. Saag, MD; and R. Pat Bucy, MD, PhD
[+] Article and Author Information

Copyright ©2004 by the American College of Physicians


Ann Intern Med. 2000;133(6):435-438. doi:10.7326/0003-4819-133-6-200009190-00011
Text Size: A A A

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 × 109 cells/L to 0.086 × 109 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.

Figures

Grahic Jump Location
Figure.
Changes in plasma viral load (squares) and absolute CD4 cell count (circles) over time in a patient with chronic HIV infection.

Viral loads less than 50 copies/mL are depicted as 1.7 log copies/mL. Broken lines indicate the period in which viral load and CD4 cell count remained stable. To convert CD4 cell counts to ×10 cells/L, divide by 1000. STI = standard treatment interruption.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Patient Who Became Acutely Ill after Stopping Anti-HIV Treatment

Copyright ©2004 by the American College of Physicians

Read More...

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)