Clinical course of primary HIV infection: Consequences for subsequent course of infection

Abstract

Objective - To investigate the impact of the clinical course of the primary HIV infection on the subsequent course of the infection. Design - Prospective documenting of seroconversion, follow up at six month intervals, and analysis of disease progression by life tables. Patients - 86 Men in whom seroconversion occurred within 12 months. Primary outcome measure - Progression of HIV infection, defined as CD4 lymphocyte count <0.5 x 109/l, recurrence of HIV antigenaemia, or progression to Centers for Disease Control group IV. Main results - Median follow up was 670 (range 45-1506) days. An acute illness like glandular fever occurred in 46 (53%) subjects. Three year progression rates to Centers for Disease Control group IV was 78% at three years for those who had longlasting illnesses (duration ≥14 days) during seroconversion as compared with 10% for those who were free of symptoms or had mild illness. All six patients who developed AIDS had had longlasting primary illnesses. Three year progression rates to a CD4 lymphocyte count <0.5 x 109/l and to recurrence of HIV antigenaemia were significantly higher for those who had longlasting primary illnesses than those who had no symptoms or mild illness (75% v 42% and 55% v 14%, respectively). Conclusion - The course of primary infection may determine the subsequent course of the infection.