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Clinical and Epidemiologic Features of Primary HIV Infection

Timothy Schacker, MD; Ann C. Collier, MD; James Hughes, PhD; Theresa Shea, PAC; and Lawrence Corey, MD
[+] Article, Author, and Disclosure Information

From the University of Washington, Seattle, Washington. Grant Support: In part by National Institutes of Health grants AI-45206 and AI-27757. Requests for Reprints: Lawrence Corey, MD, Virology Division, University of Washington, Room 9301, 1200 12th Avenue South, Seattle, WA 98144. Current Author Addresses: Drs. Shacker, Hughes, and Corey: Virology Division, University of Washington, Room 9301, 1200 12th Avenue South, Seattle, WA 98144.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;125(4):257-264. doi:10.7326/0003-4819-125-4-199608150-00001
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Background: The acute clinical events surrounding the acquisition of human immunodeficiency virus (HIV) have not been well characterized.

Objective: To further define the clinical and epidemiologic presentation of primary HIV infection.

Design: Descriptive cohort study.

Setting: University research clinic.

Patients: 46 adults (43 men and 3 women) with primary HIV infection who enrolled in the study a median of 51 days after HIV seroconversion.

Measurements: Documentation of recent HIV seroconversion. Standardized collection of demographic characteristics and sexual contact history, results of tests for HIV RNA, HIV culture, and T-cell subsets.

Results: 41 of 46 patients (89%) developed an acute retroviral syndrome. Primary HIV infection was infrequently diagnosed at the initial medical encounter, even in persons enrolled in routine HIV screening programs. Median numbers of sexual partners 6 months and 1 month before acquisition of HIV were three and one, respectively; 21 patients (46%) reported having had only one partner in the month before seroconversion. Of the 12 patients who could identify the precise date of and activity leading to seroconversion, 4 reported having only oral-genital contact.

Conclusions: Primary HIV infection causes a recognizable clinical syndrome that is often underdiagnosed, even in persons enrolled in a program of routine surveillance for HIV infection. Frequency of sexual contact and overall numbers of sexual partners in this group of homosexual men who acquired HIV were markedly lower than those seen a decade ago. Acquisition of HIV does occur, even in persons with relatively few sexual partners. Increased attention to oral-genital contact as a means of acquiring HIV appears to be warranted.


Grahic Jump Location
Figure 1. Signs and symptoms in the 41 patients who presented with symptomatic primary human immunodeficiency virus (HIV) infection. Duration of signs and symptoms of primary HIV infection in 41 patients.
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Grahic Jump Location
Figure 2.
Days from sexual exposure to onset of symptoms in 12 patients who could identify the exact date and time of the sexual exposure that led to acquisition of human immunodeficiency virus.
Grahic Jump Location




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