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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
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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
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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.


Grahic Jump Location
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




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Summary for Patients

Patient Who Became Acutely Ill after Stopping Anti-HIV Treatment

Copyright ©2004 by the American College of Physicians


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