Acute primary human immunodeficiency virus type 1 infection in a patient with concomitant cytomegalovirus encephalitis

We report what we believe is the first case of primary human immunodeficiency virus type 1 (HIV-I) infection and simultaneous cytomegalovirus (CMV) encephalitis, which was confirmed by detection of CMV DNA in the patient's cerebrospinal fluid with use of the polymerase chain reaction. This coinfection had an unusual course, and the patient's clinical status deteriorated despite administration of combination antiretroviral therapy. The patient responded clinically only after therapy for CMV infection was added to his combination antiretroviral regimen. An atypical course and duration of symptomatic primary HIV-1 infection should suggest a possible coincident infection with other opportunistic agents that are normally expected to cause disease later in the course of HIV-1 infection. Current recommendations from the Centers for Disease Control and Prevention list CMV encephalitis as an AIDS-defining event.