Primary HIV-1 infection: a new medical emergency?

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7041.1243 (Published 18 May 1996) Cite this as: BMJ 1996;312:1243
  1. Stephen Jolles,
  2. Sabine Kinloch De Loes,
  3. Margaret A Johnson,
  4. George Janossy
  1. Senior registrar in immunology Royal Free Hospital and School of Medicine, London NW3 2QG
  2. Virologist Central Laboratory of Virology, University Cantonal Hospital, Geneva, Switzerland
  3. Consultant physician in thoracic medicine/HIV Professor of immunology Royal Free Hospital and School of Medicine, London NW3 2QG

    Recognition of this initial illness may permit early diagnosis and treatment

    Patients with HIV-1 infection are usually not diagnosed until they present with an opportunistic infection, often several years after their initial seroconversion. Increasingly, however, it is recognised that many people suffer an acute mononucleosis-like illness shortly after seroconversion. Despite the protean manifestations of this initial infection, primary HIV-1 infection is now recognisable as a distinct clinical entity. The clinical findings are associated with the immune response to the rapid dissemination of HIV throughout the body and may represent an important early opportunity for diagnosis and intervention.

    Primary HIV-1 infection has been described as a “mononucleosis-like illness of acute onset occurring 2-6 weeks after HIV-1 infection, usually resolving after 1-2 weeks, though occasionally lasting considerably longer.”1 2 It has been estimated that 53-93% of gay men who have recently acquired HIV undergo an acute seroconversion illness and that most of them remain undiagnosed.3 Those with a severe and long lasting illness have a poorer long term prognosis.4

    The symptoms associated with primary HIV-1 …

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