HIV-positive patients who develop symptoms of primary HIV infection, or acute retroviral syndrome (ARS), shortly after infection with HIV, and are ill for longer with symptoms of fever, fatigue and muscle pain, progress to AIDS faster, according to the results of an international study published in the April 15th edition of the Journal of Acquired Immune Deficiency Syndromes.
Investigators from Switzerland and Australia conducted a prospective study in 70 patients with ARS. Tests revealed that all the patients had been infected with HIV in the preceding six months. Investigators recorded the presumed date of infection for each patient and the date of the onset of ARS. Symptoms of ARS were also recorded to see if specific symptoms could be associated with faster disease progression to either an AIDS-defining illness or a CD4 cell count below 200 cells/mm3.
Follow-up extended until the introduction of highly active antiretroviral therapy in mid-1995. Patients were followed for an average of two years.
Patients incubated ARS for an average of 21.5 days (range 14.7 - 34.5 days) and the average duration of ARS was 15.5 days (range nine to 19.8).
A short incubation period of ARS with symptoms of fever, muscle pain and fatigue (incubation range 21.5 - 25.5 days), and ARS lasting longer with symptoms of fever, muscle pain, fatigue, headache and joint pain (length of illness eleven to 15 days) were found to be associated with faster progression to an AIDS-defining illness or a CD4 cell count below 200 cells/mm3. Having a sore throat, rash, or mouth ulcers during ARS were not found to be associated with faster disease progression.
The investigators conclude “our findings suggest that the incubation of some features was predictive of disease progression.” The investigators suggest that the association between certain specific symptoms and faster disease progression may be a function of HIV strain or host factors.
The length of incubation could be a feature “of cytokine secretion involved in the fever process such as increased circulating IL-1, IL-6 and TNF-alpha" the authors suggest. "In the light of our analysis, these cytokines might module disease progression.”
As regards symptoms, these might reflect impaired immune control of HIV by CD8 cells. In addition, some strains of HIV could have a higher replicative capacity, causing the more rapid emergence of symptoms.
The investigators note limitations to their study, not least its reliance on patient recall of potential HIV exposures, and the short follow-up of the study.
Nevertheless, “investigations into the incubation and duration of symptoms of ARS as predictors of AIDS can provide important information that will explain the various ARS features and divergent rates of HIV disease progression.”
Further information on this website
Exposure and primary infection - overview
Primary infection - factsheet
Early short course HAART during primary infection - overview
Vanhems P et al. Incubation and duration of specific symptoms of acute retroviral syndrome as independent predictors of progression to AIDS. JAIDS 32: 542 - 544, 2003.