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

19 September 2000 | Volume 133 Issue 6 | Pages 435-438

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 10⁹ cells/L to 0.086 x 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.

Author and Article Information

From the University of Alabama at Birmingham, Birmingham, Alabama.

Presented in part at the Seventh Conference on Retroviruses and Opportunistic Infections, San Francisco, California, 30 January–2 February 2000.

Grant Support: In part by the National Institutes of Health Acute Infection and Early Disease Research Network (U01 AI 41530), the University of Alabama at Birmingham General Clinical Research Center (NCRR MO1 RR00032), and the National Institute of Allergy and Infectious Diseases (RO1 A144672). Agouron Pharmaceuticals, Inc., provided funding support for the clinical study that preceded the events in this case report.

Acknowledgments: The authors thank Karen McPheeters and Greg Sfakianos for expert assistance in coordinating the nursing care of the patient.

Requests for Single Reprints: J. Michael Kilby, MD, 1917 Clinic, University of Alabama at Birmingham, 908 20th Street South, Birmingham, AL 35294-2050.

Current Author Addresses: Drs. Kilby and Saag: 1917 Clinic, University of Alabama at Birmingham, 908 20th Street South, Birmingham, AL 35294-2050.

Drs. Goepfert and Gnann: 845 19th Street South, BBRB 220, University of Alabama at Birmingham, Birmingham, AL 35294.

Dr. Sillers: Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35233.

Dr. Bucy: Department of Pathology, SW W287, University of Alabama at Birmingham, Birmingham, AL 35294.

Author Contributions: Conception and design: J.M. Kilby, P.A. Goepfert, A.P. Miller, R.P. Bucy.

Analysis and interpretation of the data: J.M. Kilby, P.A. Goepfert, A.P. Miller, M.S. Saag, R.P. Bucy.

Drafting of the article: J.M. Kilby.

Critical revision of the article for important intellectual content: P.A. Goepfert, J.W. Gnann Jr., M.S. Saag, R.P. Bucy.

Final approval of the article: J.M. Kilby, P.A. Goepfert, J.W. Gnann Jr., M.S. Saag, R.P. Bucy.

Provision of study materials or patients: P.A. Goepfert, A.P. Miller, J.W. Gnann Jr., M. Sillers, M.S. Saag, R.P. Bucy.

Administrative, technical, or logistic support: M. Sillers, M.S. Saag, R.P. Bucy.

Collection and assembly of data: J.M. Kilby, P.A. Goepfert, R.P. Bucy.