Retroviral rebound syndrome after cessation of suppressive antiretroviral therapy in three patients with chronic HIV infection.
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.


METHODS
Case reports.


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


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


METHODS
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.


CONCLUSIONS
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.
Colven
R
R
Harborview Medical Center, 325 9th Avenue, Box 359763, Seattle, WA 98104, USA.
Harrington
R D
RD
Spach
D H
DH
Cohen
C J
CJ
Hooton
T M
TM
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D006678:HIV / Q000235:genetics; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D013577:Syndrome; D019562:Viral Load
D019380:Anti-HIV Agents; D012367:RNA, Viral