Clinical Case Report: Dengue Hemorrhagic Fever in a Patient With Acquired Immunodeficiency Syndrome

Abstract

A person diagnosed with acquired immunodeficiency syndrome in 2000 and who received highly active antiretroviral therapy developed co-infection with dengue virus in 2003. In the course of the co-infection, he developed fever, thrombocytopenia (13,700 cells/mm3), petechia, and hypoalbuminemia, which are compatible with the World Health Organization criteria for a case of dengue hemorrhagic fever. Human immunodeficiency virus was not detected 30 days before co-infection and 10 days afterwards. His CD4 cell count did not show significant alterations in the two periods evaluated. He continued his course of treatment without arterial hypotension, serious hemorrhage, or other life-threatening complications.

Differential Clinical Outcome of Dengue Infection Among Patients With and Without HIV Infection: A Matched Case–Control Study

“… 1 – 3 However, the severity and characteristics of dengue and HIV (DENV-HIV) coinfection and the reciprocal impact on disease progression remain elusive because of lack of systematic case–control analysis. 4 , 5 , 7 , 18 Thus far, case series had suggested that patients with DENV-HIV coinfection had non-severe dengue outcome and showed no signs of accelerated progression of HIV disease. 4 , 7 , 18 This may be due to the transient reduction of HIV viral load during acute dengue infection.…”

“… 4 , 5 , 7 , 18 Thus far, case series had suggested that patients with DENV-HIV coinfection had non-severe dengue outcome and showed no signs of accelerated progression of HIV disease. 4 , 7 , 18 This may be due to the transient reduction of HIV viral load during acute dengue infection. 5 Unfortunately, there is a lack of large cohort study to validate these observations.…”

“… 1 – 3 Despite the overlapping epidemiology, knowledge on the differential clinical manifestations and disease severity between DENV-HIV coinfected and DENV patients is limited. Only a handful of case reports 4 – 6 and case series were published thus far. 7…”

“…7 Furthermore, a male patient in Sao Luis, Brazil, who was coinfected, did not have any life-threatening complications although fulfilling the criteria of DHF. 4 Another study suggested that there might be a transient suppression of HIV-1 replication during an acute DENV infection. 5 Further studies suggested that this transient suppression was likely due to the role of DENV NS5 protein downregulating HIV co-receptor (CXCR4) expression and the increased production of stromal cell–derived factor 1 (SDF-1), a chemokine ligand for CXCR4.…”