Toxic shock syndrome and persistent immune activation in an HIV-positive patient

The case of an HIV-positive treatment-naive male with toxic shock syndrome (TSS) is presented herein. The course of TSS was favorable; however, the patient had extremely high plasma levels of MCP-1 and CD38 and HLA-DR expression on CD8+ T cells during the acute illness. Furthermore, the numbers of CD8+ T cells were reduced and CD4+ T cells remained stable during acute illness in comparison to baseline values. MCP-1 and HLA-DR gradually decreased, but they were still elevated after a month, whereas the number of circulating CD8+ T cells increased more than fivefold. CD38 expression remained stable during this period. A further decrease in CD38, HLA-DR and MCP-1 was noted five months after the initiation of antiretroviral therapy.