Does symptomatic primary HIV-1 infection accelerate progression to CDC stage IV disease, CD4 count below 200 x 106/l, AIDS, and death from AIDS?

BMJ 1994;309:1535-1537 (10 December)

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Does symptomatic primary HIV-1 infection accelerate progression to CDC stage IV disease, CD4 count below 200 x 10⁶/l, AIDS, and death from AIDS?

Stefan Lindback, Christina Brostrom, Anders Karlsson, Hans Gaines

Department of Infectious Diseases, Huddinge Hospital, Karolinska Institute, Stockholm, Sweden . Department of Dermatovenereology, Sodersjukhuset, Karolinska Institute, Stockholm, Sweden . Department of Clinical Immunology, Swedish Institute for Infectious Disease Control, and Department of Infectious Diseases, Huddinge Hospital, Karolinska Institute, Stockholm, Sweden . Correspondence and requests for reprints to: Dr Stefan Lindback, Department of Infectious Diseases, I 56, Huddinge Hospital, S-141 86 Huddinge, Sweden.

Abstract

Objective: To investigate the prognostic significance of symptomaticprimary HIV-1 infection.
Design: Prospective study of homosexual men seroconverting toHIV in 1985 and 1986. Patients were followed up at least threetimes yearly with clinical examinations and T cell subset determinationsfor an average of 7.2 years.
Setting: Research project centred on attenders for treatmentand screening for HIV at the Karolinska Institute, Stockholm.Subjects--19 patients presenting with a glandularfever-likeillness associated with seroconversion to HIV and 29 asymptomaticseroconverters.
Main outcome measures: Progression to Centers for Disease Controland Prevention stage IV disease, CD4 cell count below 200 x10⁶/l, AIDS, and death from AIDS.
Results: Symptomatic seroconverters were significantly morelikely to develop Centers for Disease Control and Preventionstage IV disease (95% (upsilon) 66%), CD4 cell counts below200 x 10⁶/l (84% (upsilon) 55%), and AIDS (58% (upsilon) 28%)and die of AIDS (53% (upsilon) 7%).
Conclusion: A glandular-fever-like illness associated with seroconversionto HIV-1 predicts accelerated progression to AIDS and otherHIV related diseases.

Key messages

Key messages
Seroconversion to HIV-1 is associated with a glandular-fever-like illness in about half of patients
Patients presenting with this clinical illness have a much accelerated progression of HIV infection as compared with asymptomatic seroconverters
Clinicians caring for these patients should know that within four years half progress to CD4 cell counts at which antiretroviral therapy and prophylaxis against opportunistic infections are recommended
Randomised, placebo controlled trials of zidovudine during primary HIV-1 infection have been started but long term benefit remains to be established

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