Recurrence of the acute HIV syndrome after interruption of antiretroviral therapy in a patient with chronic HIV infection: A case report.
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.


METHODS
Case report.


METHODS
University clinic.


METHODS
HIV-infected man.


METHODS
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 10(9) cells/L to 0.086 x 10(9) cells/L). Evaluation for alternative causes of fever was unrevealing. Symptoms resolved rapidly with resumption of HIV therapy.


CONCLUSIONS
Therapeutic interruption may be associated with profound viral rebound and recurrence of the acute HIV syndrome.
Kilby
J M
JM
1917 Clinic, University of Alabama at Birmingham, 908 20th Street South, Birmingham, AL 35294-2050, USA.
Goepfert
P A
PA
Miller
A P
AP
Gnann
J W
JW
Sillers
M
M
Saag
M S
MS
Bucy
R P
RP
D000208:Acute Disease; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002908:Chronic Disease; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005334:Fever / Q000821:virology*; D006678:HIV / Q000235:genetics; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology*; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D006801:Humans; D019469:Indinavir / Q000627:therapeutic use; D019259:Lamivudine / Q000627:therapeutic use; D008297:Male; D012367:RNA, Viral / Q000097:blood; D012008:Recurrence; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D013577:Syndrome; D019562:Viral Load; D015215:Zidovudine / Q000627:therapeutic use
D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D015215:Zidovudine; D019469:Indinavir