DOES SYMPTOMATIC PRIMARY HIV-1 INFECTION ACCELERATE PROGRESSION TO CDC STAGE-IV DISEASE, CD4 COUNT BELOW 200 X 10(6)/1, AIDS, AND DEATH FROM AIDS

Objective-To investigate the prognostic significance of symptomatic primary HIV-1 infection. Design-Prospective study of homosexual men seroconverting to HIV in 1985 and 1986. Patients were followed up at least three times yearly with clinical examinations and T cell subset determinations for an average of 7.2 years. Setting-Research project centred on attenders for treatment and screening for HIV at the Karolinska Institute, Stockholm. Subjects-19 patients presenting with a glandular-fever-like illness associated with seroconversion to HIV and 29 asymptomatic seroconverters. Main outcome measures-Progression to Centers for Disease Control and Prevention stage IV disease, CD4 cell count below 200 x 10(6)/1, AIDS, and death from AIDS. Results-Symptomatic seroconverters were significantly more likely to develop Centers for Disease Control and Prevention stage IV disease (95% v 66%), CD4 cell counts below 200 x 10(6)/1 (84% v 55%), and AIDS (58% v 28%) and die of AIDS (53% v 7%). Conclusion-A glandular-fever-like illness associated with seroconversion to HIV-1 predicts accelerated progression to AIDS and other HIV related diseases.