Cited by 705HIV/AIDS Research and InterventionsHIV Research and TreatmentHIV-related health complications and treatments

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Clinical and epidemiologic features of primary HIV infection.

Schacker, Timothy, Collier, Ann C., Hughes, James, Shea, Theresa, Corey, Lawrence·1996·Annals of Internal Medicine

DOI 10.7326/0003-4819-125-4-199608150-00001

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Abstract

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.

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Activation of HIV-1 specific CD4 and CD8 T cells by human dendritic cells: roles for cross-presentation and non-infectious HIV-1 virus
Larsson, M., Fonteneau, J., Lirvall, M., Haslett, P. A. J., Lifson, J. D., & Bhardwaj, N. (2002) · AIDS · doi:10.1097/00002030-200207050-00003 · Cited by 119
“As immune responses are generated by HIV-1 infection [31], the host must have evolved alternative approaches for efficient antigen presentation.”
Background
Acute Primary HIV Infection
Quinn, T. C. (1997) · JAMA · doi:10.1001/jama.1997.03550010072043 · Cited by 120
Productive Infection of T Cells in Lymphoid Tissues during Primary and Early Human Immunodeficiency Virus Infection
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“Four of the patients had biopsies performed within 15 days of the onset of symptoms or ∼3–4 weeks after the onset of infection, on the basis of a median incubation period of 12–14 days from exposure to the onset of symptoms [26] (table 1).”
BackgroundSelf-citation
Diagnosis and Management of Acute HIV Infection
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Early and Persistent Human Immunodeficiency Virus Type 1 (HIV‐1)–Specific T Helper Dysfunction in Blood and Lymph Nodes following Acute HIV‐1 Infection
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“Thirty-nine patients with early HIV-1 infection were enrolled in this study; they were participants in a longitudinal study conducted at the University of Washington Primary HIV Clinic [10, 11].”
BackgroundMethodSelf-citation
Multiple V1/V2 env Variants Are Frequently Present during Primary Infection with Human Immunodeficiency Virus Type 1
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“Primary infection symptoms begin, on average, 2 weeks after infection (3, 31, 45, 54), most likely the result of the initial immune response.”
Background
Treatment of Primary Human Immunodeficiency Virus Type 1 Infection with Potent Antiretroviral Therapy Reduces Frequency of Rapid Progression to AIDS
Berrey, M. M., Schacker, T. W., Collier, A. C., Shea, T., Brodie, S. J., Mayers, D. L., Coombs, R. W., Krieger, J. N., Chun, T., Fauci, A. S., et al. (2001) · The Journal of Infectious Diseases · doi:10.1086/320189 · Cited by 111
“To evaluate the effects of immediate therapy on clinical outcome, we compared the virologic and clinical course of patients with primary HIV-1 infection who were seen within 90 days of onset of acute retroviral illness or within 90 days of a documented acute asymptomatic HIV-1 seroconversion [28-31].”
BackgroundMethodResultInfluentialSelf-citation
Sexually Transmitted Diseases in Men Who Have Sex With Men: Acquisition of Gonorrhea and Nongonococcal Urethritis by Fellatio and Implications for STD/HIV Prevention
LAFFERTY, W. E., HUGHES, J. P., & HANDSFIELD, H. H. (1997) · Sexually Transmitted Diseases · doi:10.1097/00007435-199705000-00007 · Cited by 113
Self-citation
FDG-PET Imaging in HIV Infection and Tuberculosis
Sathekge, M. M., Maes, A., & de Wiele, C. V. (2013) · Seminars in Nuclear Medicine · doi:10.1053/j.semnuclmed.2013.04.008 · Cited by 113
Simian Immunodeficiency Virus Disease Course Is Predicted by the Extent of Virus Replication during Primary Infection
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“This peak SIVmac251 viremia is also higher than that reported in most primary HIV-1 infection studies, although human studies can only rarely precisely pinpoint peak viremia (35, 49, 68, 69).”
Abnormalities in Resting-State Functional Connectivity in Early Human Immunodeficiency Virus Infection
Wang, X., Foryt, P., Ochs, R., Chung, J.-H., Wu, Y. G., Parrish, T. B., & Ragin, A. B. (2011) · Brain Connectivity · doi:10.1089/brain.2011.0016 · Cited by 112
“As host immune defenses are mounted, levels of HIV RNA in plasma generally decline to a steady state that may be undetectable in many individuals for long periods (Schacker et al., 1996).”
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Smith, P. D., Meng, G., Salazar-Gonzalez, J. F., & Shaw, G. M. (2003) · Journal of Leukocyte Biology · doi:10.1189/jlb.0503219 · Cited by 117
“contact [1–3], but the orogenital route appears to be consider-”
Background
Salivary Secretory Leukocyte Protease Inhibitor Is Associated with Reduced Transmission of Human Immunodeficiency Virus Type 1 through Breast Milk
Farquhar, C., VanCott, T. C., Mbori‐Ngacha, D., et al. (2002) · The Journal of Infectious Diseases · doi:10.1086/343805 · Cited by 111
HIV-1 seroconversion in a prospective study of female sex workers in northern Thailand
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“in primary HIV infection [31], and this condition may”
Background
Genetic Association of the Antiviral Restriction Factor TRIM5α with Human Immunodeficiency Virus Type 1 Infection
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“In addition, we included 140 HIV-1-infected participants in the University of Washington Primary Infection Clinic, whose enrollment criteria have been previously reported ( 40 , 41).”
Background
Human Immunodeficiency Virus Type 1envEvolves toward Ancestral States upon Transmission to a New Host
Herbeck, J. T., Nickle, D. C., Learn, G. H., Gottlieb, G. S., Curlin, M. E., Heath, L., & Mullins, J. I. (2006) · Journal of Virology · doi:10.1128/jvi.80.4.1637-1644.2006 · Cited by 104
“nine subjects in the University of Washington PIC (21, 35).”
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Postexposure Prophylaxis in Children and Adolescents for Nonoccupational Exposure to Human Immunodeficiency Virus
Havens, P. L. (2003) · PEDIATRICS · doi:10.1542/peds.111.6.1475 · Cited by 96
Risk-Based Human Immunodeficiency Virus (HIV) Testing Fails to Detect the Majority of HIV-Infected Persons in Medical Care Settings
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“27 MSM 15 (47) 48 (61) IDU 4 (13) 10 (13) Heterosexual 8 (25) 12 (15) MSM IDU 0 (0) 5 (6) Other/unknown 5 (16) 4 (5) CD4 T-cell count (cells/ l)* 40 (20–96) 518 (346–646) 0.”
Improved detection of acute HIV-1 infection in sub-Saharan Africa: development of a risk score algorithm
Powers, K. A., Miller, W. C., Pilcher, C. D., Mapanje, C., Martinson, F. E. A., Fiscus, S. A., Chilongozi, D., Namakhwa, D., Price, M. A., Galvin, S., et al. (2007) · AIDS · doi:10.1097/qad.0b013e3282f08b4d · Cited by 101
“Furthermore, the identified symptoms are consistent with those of acute retroviral syndrome, seen in up to 90% of recently infected individuals [10,11].”
BackgroundMethod
Host Determinants in HIV Infection and Disease: Part 1: Cellular and Humoral Immune Responses*
Hogan, C., & Hammer, S. M. (2001) · Annals of Internal Medicine · doi:10.7326/0003-4819-134-9_part_1-200105010-00013 · Cited by 100
Induction of Plasma (TRAIL), TNFR-2, Fas Ligand, and Plasma Microparticles after Human Immunodeficiency Virus Type 1 (HIV-1) Transmission: Implications for HIV-1 Vaccine Design
Gasper-Smith, N., Crossman, D. M., Whitesides, J. F., Mensali, N., Ottinger, J. S., Plonk, S. G., Moody, M. A., Ferrari, G., Weinhold, K. J., Miller, S., et al. (2008) · Journal of Virology · doi:10.1128/jvi.00605-08 · Cited by 99
“The eclipse phase of HIV-1 infection (from transmission until the appearance of plasma viremia) is estimated to be 10 days in length, with a range of 7 to 21 days (14, 16, 18, 24, 25, 46, 59).”
Background
Acute HIV Infection Induces Mucosal Infiltration With CD4+ and CD8+ T Cells, Epithelial Apoptosis, and a Mucosal Barrier Defect
Epple, H., Allers, K., Tröger, H., Kühl, A. A., Erben, U., Fromm, M., Zeitz, M., Loddenkemper, C., Schulzke, J., & Schneider, T. (2010) · Gastroenterology · doi:10.1053/j.gastro.2010.06.065 · Cited by 99
HIV-1 Envelope Subregion Length Variation during Disease Progression
Curlin, M. E., Zioni, R., Hawes, S. E., Liu, Y., Deng, W., Gottlieb, G. S., Zhu, T., & Mullins, J. I. (2010) · PLoS Pathogens · doi:10.1371/journal.ppat.1001228 · Cited by 98
“We analyzed new and published HIV-1 envelope gene sequences and associated clinical data from all available subjects in the Seattle Primary Infection Cohort (PIC) [49], the Multicenter AIDS Cohort Study (MACS) [50], and from the Los Alamos National Laboratories HIV database (HIVDB) (http://www.”
MethodInfluential
Viral meningitis: current issues in diagnosis and treatment
McGill, F., Griffiths, M. J., & Solomon, T. (2017) · Current Opinion in Infectious Diseases · doi:10.1097/qco.0000000000000355 · Cited by 101
NATURAL HISTORY OF HIV-1 INFECTION
Vergis, E. N., & Mellors, J. W. (2000) · Infectious Disease Clinics of North America · doi:10.1016/s0891-5520(05)70135-5 · Cited by 97
Infrequent Diagnosis of Primary Human Immunodeficiency Virus Infection
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Virus Population Homogenization following Acute Human Immunodeficiency Virus Type 1 Infection
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“We addressed the origins of the homogeneous virus populations found early in HIV-1 infection through examination of the first eight patients seen at the University of Washington Primary Infection Clinic who presented within 66 days of onset of acute HIV-1 infection (13, 21, 23).”
BackgroundSelf-citation
Cerebrospinal Fluid Viral Load, Intrathecal Immunoactivation, and Cerebrospinal Fluid Monocytic Cell Count in HIV-1 Infection
Gisslén, M., Fuchs, D., Svennerholm, B., et al. (1999) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/00126334-199908010-00003 · Cited by 96
HIV Pathogenesis: The HostPreprint
Lackner, A. A., Lederman, M. M., & Rodriguez, B. A. (2012) · Cold Spring Harbor Perspectives in Medicine · doi:10.1101/cshperspect.a007005 · Cited by 107
“Most persons who become HIV infected experience an illness characterized often by fever, sore throat, lymphadenopathy, and rash (Schacker et al. 1996).”
Oral sex, oral health and orogenital infections
Saini, R., Saini, S., & Sharma, S. (2010) · Journal of Global Infectious Diseases · doi:10.4103/0974-777x.59252 · Cited by 93

Authors: Schacker, T., Collier, A. C., Hughes, J., Shea, T., & Corey, L.
Affiliations: University of Washington (US)
Corresponding author: Schacker, Timothy
ORCID: Schacker, Timothy
Collier, Ann C.
Corey, Lawrence
Venue: Annals of Internal Medicine
Publisher: American College of Physicians
Published: 1996-08-15
Volume: 125
Issue: 4
Pages: 257-264
ISSN: 0003-4819 (ISSN-L)
1539-3704
DOI: 10.7326/0003-4819-125-4-199608150-00001
OpenAlex: W2008972159
Cited by: 703
References: 0
Citations by year: 2026: 3 · 2025: 3 · 2024: 6 · 2023: 9 · 2022: 9 · 2021: 9 · 2020: 12 · 2019: 15 · 2018: 17 · 2017: 17 · 2016: 20 · 2015: 21 · 2014: 31 · 2013: 33 · 2012: 32
FWCI: 28.00
Type: journal article
Language: en
Open access: closed
Licence: www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations: Annals of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (n01ai045206-013)
National Institute of Allergy and Infectious Diseases (AI 27757, AI-45206, P30AI027757)
Topics: Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Life Sciences › Immunology and Microbiology › Virology › HIV Research and Treatment
Health Sciences › Medicine › Infectious Diseases › HIV-related health complications and treatments
Keywords: primary HIV infection, acute retroviral syndrome, HIV seroconversion, underdiagnosis, sexual partners, oral-genital contact, gay men, HIV transmission, T cell subsets, HIV RNA
MeSH terms: Adult, Female, HIV, HIV Seropositivity, Homosexuality, Humans, Male, Risk Factors, RNA, Viral, Time Factors, United States, Washington, HIV Infections, Polymerase Chain Reaction, HIV Core Protein p24, CD4 Lymphocyte Count

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Clinical and epidemiologic features of primary HIV infection.

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