Acute HIV infection presenting as hemophagocytic syndrome with an unusual serological and virological response to ARTReport as inadecuate

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BMC Infectious Diseases

, 16:619

HIV and co-infections


BackgroundHIV clinical presentation in the acute stage is variable and some of its virological and immunological aspects are not completely understood. Most cases of HIV- associated reactive hemophagocytic syndrome have been reported in patients with advanced stages of HIV and to our knowledge, there are only 8 cases in the English literature presenting during acute HIV infection, most in East Asia, being this the first case in a European patient.

Case presentationWe report a case of a European Caucasian 27- year old woman with a primary HIV- infection presenting with extremely low CD4+ T cell count who developed a haemophagocytic syndrome after starting ART and in whom we documented a very unusual serological and virological response, characterized by an impaired HIV- antibody production and a 12 month time frame to reach an undetectable viral load, despite no evidence of resistance.

ConclusionsThis case report apart from describing an unusual clinical presentation of an acute HIV infection as hemophagocytic syndrome provides useful information that might contribute for understanding some subtle issues in acute HIV infection, namely the dynamics of virological and immunological aspects after antiretroviral therapy initiation.

KeywordsHIV Acute infection Haemophagocytic syndrome AbbreviationsALKAlkaline phosphatise

ALTAlanine aminotransferase

ARTAntiretroviral therapy

ASTAspartate aminotransferase


CRPC-reactive protein


EBVEpstein barr virus




HBs AbHepatitis B surface antibody

HIVHuman immunodeficiency virus

IRISImmune reconstitution syndrome

LDHLactate dehydrogenase

NNRTIsNon-nucleoside reverse transcriptase inhibitors

NRTIsNucleoside reverse transcriptase inhibitors

PCRPolymerase chain reaction

PIProtease inhibitor



TDMTherapeutic drug monitoring

WBCWhite blood cells

Electronic supplementary materialThe online version of this article doi:10.1186-s12879-016-1945-9 contains supplementary material, which is available to authorized users.

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Author: Rita Veiga Ferraz - Ana Cláudia Carvalho - Fernando Araújo - Carmo Koch - Cândida Abreu - António Sarmento


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