Can Therapy Interruption During Chronic Infection Cause an Acute Retroviral Syndrome?

Acute HIV infection is associated with a clinicalsyndrome characterized by fever, fatigue, pharyngitis,lymphadenopathy, rash and weight loss intwo thirds of patients. In 1998, Daar et al. publishedan intriguing report of a patient who initiatedanitretroviral therapy during acute HIV infectionbefore antibody seroconversion (Ann Intern Med1998; 128: 827-9). After 6 months of treatment, thepatient elected to discontinue therapy. His viralload precipitously increased, CD4 cells declinedand he developed a syndrome identical to theacute retroviral syndrome. Daar postulated thatearly therapy delayed the full immunologic responseto infection and clinical manifestations ofacute HIV infection were unmasked when uncontrolledviral replication resumed.