Retroviral Rebound Syndrome after Cessation of Suppressive Antiretroviral Therapy in Three Patients with Chronic HIV Infection

  1. Roy Colven, MD;
  2. Robert D. Harrington, MD;
  3. David H. Spach, MD;
  4. Calvin J. Cohen, MD; and
  5. Thomas M. Hooton, MD
  1. From Harborview Medical Center, Seattle, Washington; and Harvard Vanguard Medical Associates, Boston, Massachusetts.

    Abstract

    Background: Although viral rebound follows cessation of suppressive antiretroviral therapy in chronic HIV infection, a viremic clinical syndrome has not been described.

    Objective: To describe a retroviral syndrome associated with cessation of effective antiretroviral therapy in chronic HIV infection.

    Design: Case reports.

    Setting: Outpatient HIV specialty clinics in Seattle, Washington, and Boston, Massachusetts.

    Patients: Three patients with chronic HIV infection who discontinued suppressive antiretroviral therapy.

    Measurements: Clinical course, plasma HIV RNA levels, and CD4 cell counts before, during, and after cessation of antiretroviral therapy.

    Results: Within 6 weeks after stopping antiretroviral therapy, each patient experienced a clinical illness that resembled a primary HIV syndrome. This coincided with a marked increase in HIV RNA level and, in two of three patients, a decrease in CD4 cell count. After antiretroviral therapy was restarted, each patient's symptoms rapidly resolved in association with resuppression of HIV RNA and increase in CD4 cell count or percentage.

    Conclusion: A retroviral rebound syndrome similar to that seen in primary HIV syndrome can occur in patients with chronic HIV infection after cessation of suppressive antiretroviral therapy.

    Article and Author Information

    • Requests for Single Reprints: Roy Colven, MD, Harborview Medical Center, 325 9th Avenue, Box 359763, Seattle, WA 98104.

    • Current Author Addresses: Dr. Colven: Harborview Medical Center, 325 9th Avenue, Box 359763, Seattle, WA 98104.

    • Drs. Harrington, Spach, and Hooton: Harborview Medical Center, 325 9th Avenue, Box 359930, Seattle, WA 98104.

    • Dr. Cohen: Harvard Vanguard Medical Associates, 133 Brookline Avenue, Boston, MA 02215.

    • Author Contributions: Conception and design: R. Colven, R.D. Harrington, D.H. Spach, T.M. Hooton.

    • Analysis and interpretation of the data: R. Colven, R.D. Harrington, D.H. Spach, T.M. Hooton.

    • Drafting of the article: R. Colven, D.H. Spach, T.M. Hooton.

    • Critical revision of the article for important intellectual content: R. Colven, R.D. Harrington, D.H. Spach, C. Cohen, T.M. Hooton.

    • Final approval of the article: R. Colven, R.D. Harrington, D.H. Spach, C. Cohen, T.M. Hooton.

    • Provision of study materials or patients: R. Colven, R.D. Harrington, D.H. Spach, C. Cohen, T.M. Hooton.

    • Collection and assembly of data: R. Colven, R.D. Harrington, T.M. Hooton.

    Summary for Patients

    • Summaries for Patients:A Report of Three HIV-Infected Patients Who Became Acutely Ill after Stopping Their Anti-HIV Treatment Ann Intern Med September 19, 2000 133:I-37
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    This Article

    1. Ann Intern Med September 19, 2000 vol. 133 no. 6 430-434
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