Acute HIV infection is rarely recognized as the signs and symptoms are normally unspecific and can persist for days or weeks. The normal HIV course is characterized by a progressive loss of CD4+ cells, which normally leads to severe immunodeficiency after a variable time interval. The mean time from initial infection to development of clinical AIDS is approximately 8-10 years, but it is variable among individuals and depends on a complex interaction between virus and host. Here we describe an extraordinary case of a man who developed Pneumocisits jiroveci pneumonia within one month after sexual exposure to HIV-1, and then presented with 3 consecutive CD4 counts bellow 200 cells/mm3 within 3 months, with no other opportunistic disease. Although antiretroviral therapy (AZT+3TC+ATZ/r) was started, with full adherence of the patient, and genotyping indicating no primary antiretroviral resistance mutations, he required more than six months to have a CD4 restoration to levels above 200 cells/mm3 and 10 months to HIV-RNA to become undetectable.
Journal Information
Vol. 14. Issue 3.
Pages 291-293 (May - June 2010)
Vol. 14. Issue 3.
Pages 291-293 (May - June 2010)
Case report
Open Access
Acute HIV infection with rapid progression to AIDS
Visits
3719
Marcio de Oliveira Silva1,
, Milena Bastos1, Eduardo Martins Netto1, Nancy Alves de Lima Gouvea2, Alex Jose Leite Torres1, Esper Kallas2, David I. Watkins3, Marcus Altfeld4, Carlos Brites1
Corresponding author
oliveiras_m@yahoo.com.br
Correspondence to: Rua Jorge Simões, 156 Ed. San Juan, apt. 302, Bonfim Salvador – Bahia – Brazil CEP: 40415-720.
Correspondence to: Rua Jorge Simões, 156 Ed. San Juan, apt. 302, Bonfim Salvador – Bahia – Brazil CEP: 40415-720.
This item has received
Article information
Abstract
Keywords:
HIV
acute infection
progression
AIDS
Full text is only aviable in PDF
References
[1.]
J.O. Kahn, B.D. Walker.
Acute human immunodeficiency virus type 1 infection.
N Engl J Med, 339 (1989), pp. 33-39
[2.]
A. Munoz, M.C. Wang, S. Bass, et al.
Acquired immunodeficiency syndrome (AIDS)-free time after human immunodeficiency virus type 1(HIV-1) seroconversion in homosexual men.
Am J Epidemiol, 130 (1989), pp. 530-539
[3.]
G.W. Rutherford, A.R. Lifson, N.A. Hessol, et al.
Course of HIV-1 infection in a cohort of homosexual and bisexual men: an 11 year follow up study.
Br Med J, 301 (1990), pp. 1183-1188
[4.]
P. Baccheti, A.R. Moss.
Incubation period of AIDS in San Francisco.
Nature, 16 (1989), pp. 251-253
[5.]
M. Stevenson.
HIV-1 pathogenesis.
Nature Medicine, 9 (2003), pp. 853-860
[6.]
B. Rodriguez, A.K. Sethi, V.K. Cheruvu, et al.
Predictive value of plasma HIV RNA level on rate of CD4 T-cell decline in untreated HIV infection.
JAMA, 296 (2006 Sep 27), pp. 1498-1506
[7.]
J.W. Mellor, C.R. Rinaldo Jr., P. Gupto, et al.
Prognosis in HIV-1 infection predicted by the quantity of virus in plasma.
Science, 272 (1996), pp. 1167-1170
[8.]
R. Harrigan.
Predicting response to CCR5 Antagonists. Oral Session.
16th Conference on Retroviruses and Opportunistic Infections,
[9.]
A.R. Lifson, G.W. Rutherford, H.W. Jaffe.
The natural history of human immunodeficiency virus infection.
J Infect Dis, 158 (1998), pp. 1360-1367
[10.]
M. Magierowska, I. Theodorou, P. Debré, et al.
Combined genotypes of CCR5, CCR2. SDF1, and HLA genes on predict the long-term nonprogressor status in human immunodeficiency virus 1 infected individuals.
Blood, 93 (1999), pp. 936-941
[11.]
P.O. Flores-Villanueva, E.J. Yunis, J.C. Delgado, et al.
Control of HIV-1 viremia and protection from AIDS are associated with HLA BW4 homozygosity.
Proc Natl Acad Sci USA, 98 (2001), pp. 5140-5145
[12.]
Gange S. Data on natural history. Symposium on the Case of Rapidly Progressive Multi-drug Resistant HIV in New York City, February 10, 2005.
[13.]
J. Phair, L. Jacobson, R. Detils, et al.
acquired immunodefiency syndrome occurring within 5 years of infection with human immunodeficiency virus type-1: The Multicenter AIDS Cohort Study.
JAIDS, 5 (1992), pp. 490-496
[14.]
M. Markowitz, H. Mohri, S. Mehandru, et al.
Infection with multidrug resistant, dual-tropic HIV-1 and rapid progression to AIDS: a case report.
Lancet, 365 (2005), pp. 1031-1038
[15.]
S. Vento, G. Di Perri, T. Garofano, et al.
Pneumocystis carinii pneumonia during primary HIV-1 infection.
Lancet, 342 (1993), pp. 24-25
[16.]
M. Carrington, G.W. Nelson, M.P. Martin, et al.
HLA and HIV-1: heterozygote advantage and B*35-CW*04 disadvantage.
Science, 283 (1999), pp. 1748-1752
[17.]
S. Itescu, U. Marthur-Wagh, M.L. Skovron, et al.
HLA- B35 is associated with accelerated progression to AIDS.
J Acquir Immune Defic Syndr, 5 (1992), pp. 37-45
[18.]
T. Sahmoud, Y. Laurian, C. Gazengel, Y. Sultan, C. Gautreau, D. Costagliola.
Progression to AIDS in French haemophiliacs: association with HLA-B35.
AIDS, 7 (1993), pp. 497-500
[19.]
X. Gao, G.W. Nelson, P. Karacki, et al.
Effect of a single amino acid change in MHC class I molecules on the rate of progression to AIDS.
N Engl J Med, 344 (2001), pp. 1688-1775
[20.]
B.S. Taylor, M.E. Sobieszczyk, F.E. McCutchan, et al.
The challenge of HIV-1 subtype diversity.
N Engl J Med, 10 (2008), pp. 1590-1602
Copyright © 2010. Elsevier Editora Ltda.. All rights reserved