Incidence and prognostic significance of symptomatic primary human immunodeficiency virus type 1 infection in homosexual men.

To investigate the incidence of symptomatic primary human immunodeficiency virus type 1 (HIV-1) infection and its prognostic significance for HIV-1 disease progression, data for 328 homosexual men from four cohort studies were evaluated. Rates of diarrhea, fever, night sweats, cough, and fatigue prior to, during, and after seroconversion were compared by use of Poisson regression, and the prognostic significance of these symptoms was evaluated with survival methods. The incidence of all symptoms was elevated during seroconversion; however, only fever was associated with faster disease progression. Seven or more days of fever was reported by 13.8% of subjects; half of them developed AIDS within 6 years, whereas only one-fourth of the men without fever developed AIDS within 6 years. In addition, fever was the only symptom associated with shortened survival and increased CD4 cell loss. Persons experiencing prolonged periods of fever during seroconversion should therefore be considered for early treatment, including prophylaxis against opportunistic infections and combinations of antiretroviral drugs.