indinavir-sulfate and Fever

Clinical and virologic consequences of temporary interruption of HIV therapy are incompletely understood.. To describe a febrile illness that was consistent with the acute HIV syndrome and occurred after interruption of antiretroviral therapy.. Case report.. University clinic.. HIV-infected man.. Plasma viral load, lymphocyte subsets, diagnostic evaluation (including cultures and serologic tests), and analysis of lymph node tissue.. 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.. Therapeutic interruption may be associated with profound viral rebound and recurrence of the acute HIV syndrome.

Topics: Acute Disease; Adult; Anti-HIV Agents; CD4 Lymphocyte Count; Chronic Disease; Disease Progression; Drug Therapy, Combination; Fever; HIV; HIV Infections; HIV Protease Inhibitors; Humans; Indinavir; Lamivudine; Male; Recurrence; Reverse Transcriptase Inhibitors; RNA, Viral; Syndrome; Viral Load; Zidovudine

This case report describes a 32-year-old woman treated with indinavir who developed mild to moderate flank pain, malaise, and low-grade fever. Sterile pyuria preceded increased serum creatinine levels. Workup revealed persistent pyuria, normal-sized kidneys, a normal intravenous pyelography, and negative urinary cultures. Renal biopsy showed interstitial nephritis and chronic inflammation. Collecting ducts contained crystals. Two months after treatment with indinavir was discontinued, serum creatinine levels returned to normal and pyuria disappeared. Sterile pyuria in patients taking indinavir may help to identify patients at risk for renal dysfunction and interstitial nephritis. Markedly increasing the fluid intake above the recommended dosage may ameliorate or even reverse the process of tubulointerstitial disease.

Topics: Adult; Female; Fever; HIV Infections; HIV Protease Inhibitors; HIV-1; Humans; Indinavir; Nephritis, Interstitial; Pain; Pyuria

Topics: Abdominal Pain; Adult; Anti-HIV Agents; Dermatitis, Exfoliative; Fever; HIV Infections; Humans; Indinavir; Male; Renal Insufficiency