Acute HIV Syndrome after Discontinuation of Antiretroviral Therapy in a Patient Treated before Seroconversion (1998)

Brief Communications15 May 1998Acute HIV Syndrome after Discontinuation of Antiretroviral Therapy in a Patient Treated before SeroconversionEric S. Daar, MD, Jiexin Bai, MD, Mary Ann Hausner, MS, Martin Majchrowicz, MPH, Mojgan Tamaddon, BA, and Janis V. Giorgi, PhDEric S. Daar, MDFrom Cedars-Sinai Burns and Allen Research Institute and the University of California, Los Angeles, Los Angeles, California., Jiexin Bai, MDFrom Cedars-Sinai Burns and Allen Research Institute and the University of California, Los Angeles, Los Angeles, California., Mary Ann Hausner, MSFrom Cedars-Sinai Burns and Allen Research Institute and the University of California, Los Angeles, Los Angeles, California., Martin Majchrowicz, MPHFrom Cedars-Sinai Burns and Allen Research Institute and the University of California, Los Angeles, Los Angeles, California., Mojgan Tamaddon, BAFrom Cedars-Sinai Burns and Allen Research Institute and the University of California, Los Angeles, Los Angeles, California., and Janis V. Giorgi, PhDFrom Cedars-Sinai Burns and Allen Research Institute and the University of California, Los Angeles, Los Angeles, California.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-128-10-199805150-00005 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Primary HIV infection is associated with high levels of viral replication and the development of HIV-specific immune responses [1-5]. Treating patients during primary HIV infection is recommended [6], but little is known about the effects of such therapy [7-9]. We report the results of virologic and immunologic studies in a patient who began receiving antiretroviral therapy during primary HIV infection and chose to discontinue therapy after 6 months.Case ReportA 38-year-old homosexual man presented on day 5 of an acute retroviral syndrome characterized by fever, pharyngitis, myalgia, headache, lymphadenopathy, and rash. The patient's leukocyte count was 2.6 × 109/L, ...References1. Daar ES, Moudgil T, Meyer RD, Ho DD. Transient high levels of viremia in patients with primary human immunodeficiency virus type 1 infection. N Engl J Med. 1991; 324:961-4. Google Scholar2. Koup RA, Safrit JT, Cao Y, Andrews CA, McLeod G, Borkowsky W, et al. Temporal association of cellular immune responses with the initial control of viremia in primary human immunodeficiency virus type 1 syndrome. J Virol. 1994; 68:4650-5. Google Scholar3. Piatak M Jr, Yang LC, Luk KC, Lifson JD, Saag MS, Clark SJ, et al. Viral dynamics in primary HIV-1 infection [Letter]. Lancet. 1993; 341:1099. Google Scholar4. Schacker T, Collier AC, Hughes J, Shea T, Corey L. Clinical and epidemiologic features of primary HIV infection. Ann Intern Med. 1996; 125:257-64. Google Scholar5. Musey L, Hughes J, Schacker T, Shea T, Corey L, McElrath MJ. Cytotoxic-T-cell responses, viral load, and disease progression in early human immunodeficiency virus type 1 infection. N Engl J Med. 1997; 337:1267-74. Google Scholar6. Carpenter CC, Fischl MA, Hammer SM, Hirsch MS, Jacobsen DM, Katzenstein DA, et al. Antiretroviral therapy for HIV infection in 1997. Updated recommendations of the International AIDS Society-USA Panel. JAMA. 1997; 277:1962-9. Google Scholar7. Markowitz M, Cao Y, Vesanen M, Talal A, Nixon D, Hurley A, et al. Recent HIV infection treated with AZT, 3TC, and a potent protease inhibitor [Abstract]. Proceedings of the 4th Conference on Retroviruses and Opportunistic Infections. Washington, DC; 1997:207. Google Scholar8. Lafeuillade A, Poggi C, Tamalet C, Profizi N, Tourres C, Costes O. Effects of a combination of zidovudine, didanosine, and lamivudine on primary human immunodeficiency virus type 1 infection. J Infect Dis. 1997; 175:1051-5. Google Scholar9. Perrin L, Rakik A, Yerly S, Baumberger C, Kinloch-de Loes S, Pechere M, et al. Combined therapy with zidovudine and L-697,661 in primary HIV infection. AIDS. 1996; 10:1233-7. Google Scholar10. Daar ES, Chernyavskiy T, Zhao JQ, Krogstad P, Chen IS, Zack JA. Sequential determination of viral load and phenotype in human immunodeficiency virus type 1 infection. AIDS Res Hum Retroviruses. 1995; 11:3-9. Google Scholar11. Ferbas J, Daar ES, Grovit-Ferbas K, Lech WJ, Detels R, Giorgi JV, et al. Rapid evolution of human immunodeficiency virus strains with increased replicative capacity during the seronegative window of primary infection. J Virol. 1996; 70:7285-9. Google Scholar12. Giorgi JV, Ho HN, Hirji K, Chou CC, Hultin LE, O'Rourke S, et al. CD8+ lymphocyte activation at human immunodeficiency virus type 1 seroconversion: development of HLA-DR+ CD38+ CD8+ cells is associated with subseuent stable CD4+ cell levels. The Multicenter AIDS Cohort Study Group. J Infect Dis. 1994; 170:775-81. Google Scholar13. Ho HN, Hultin LE, Mitsuyasu RT, Matud JL, Hausner MA, Bockstoce D, et al. Circulating HIV-specific CD8+ cytotoxic T cells express CD38 and HLA-DR antigens. J Immunol. 1993; 150:3070-9. Google Scholar14. Hoen B, Harzic M, Dumon B, Lascoux C, Gomard E, Venet A, et al. Efficacy of zidovudine, lamivudine, and ritonavir combination in patients with symptomatic primary HIV infection: the ANRS 053/538 trial. Can eradication be obtained? [Abstract] 5th Conf Retro and Opportun Infect. 1998:524. Google Scholar15. Selin LK, Welsh RM. Cytolytically active memory CTL present in lymphocytic choriomeningitis virus-immune mice after clearance of virus infection. J Immunol. 1997; 158:5366-73. Google Scholar16. Lau LL, Jamleson BD, Somasundaram T, Ahmed R. Cytotoxic T-cell memory without antigen. Nature. 1994; 369:648-52. Google Scholar17. Beverley PC. Is T-cell memory maintained by crossreactive stimulation? Immunol Today. 1990; 11:203-5. Google Scholar18. Cavert W, Notermans DW, Staskus K, Wletgrefe SW, Zupancic M, Gebhard K, et al. Kinetics of response in lymphoid tissues to antiretroviral therapy of HIV-1 infection. Science. 1997; 276:960-4. Google Scholar19. Perelson AS, Essunger P, Cao Y, Vesanen M, Hurley A, Saksela K, et al. Decay characteristics of HIV-1-infected compartments during combination therapy. Nature. 1997; 387:188-91. Google Scholar20. Chun TW, Carruth L, Finzi D, Shen X, DiGiuseppe JA, Taylor H, et al. Quantification of latent tissue reservoirs and total body viral load in HIV-1 infection. Nature. 1997; 387:183-8. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Cedars-Sinai Burns and Allen Research Institute and the University of California, Los Angeles, Los Angeles, California.Acknowledgments: The authors thank Stephen Nichols, MD, for technical assistance; Jacqui Pitt, RN, for clinical assistance; Marie Reskusic for figure preparation; and John Ferbas, PhD, for critical review of the manuscript. They also thank the patient, who cooperated with all studies and reviewed the manuscript to assure accuracy of the description of the clinical syndrome.Grant Support: In part by the Universitywide AIDS Research Program California Multicenter AIDS Research Consortium Award and National Institutes of Health grant AI-32883.Corresponding Author: Eric S. Daar, MD, Division of Infectious Diseases, Cedars-Sinai Medical Center, B217, 8700 Beverly Boulevard, Los Angeles, CA 90048.Current Author Addresses: Drs. Daar and Bai and Ms. Tamaddon: Division of Infectious Diseases, Cedars-Sinai Medical Center, B217, 8700 Beverly Boulevard, Los Angeles, CA 90048. 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Pat Bucy, MD, PhDPrimary HIV infectionAntiretroviral Therapy during Primary Immunodeficiency Virus Infection Can Induce Persistent Suppression of Virus Load and Protection from Heterologous Challenge in Rhesus MacaquesHuman anti-HIV-1 tat sFv intrabodies for gene therapy of advanced HIV-1-infection and AIDSThe challenge of immune control of immunodeficiency virusDynamics of viral load rebound and immunological changes after stopping effective antiretroviral therapyFailure to Learn Human Immunodeficiency Virus Test Results in Los Angeles Public Sexually Transmitted Disease Clinics 15 May 1998Volume 128, Issue 10Page: 827-829KeywordsAntibodiesAntiretroviral therapyBlood plasmaCellsCytotoxic T cellsHIVHIV infectionsImmune responseMemoryRNA Issue Published: 15 May 1998 CopyrightCopyright © 1998 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...