Acute human immunodeficiency virus type 1 disease as a mononucleosis- like illness: is the diagnosis too restrictive?

The purpose of this study was to describe the frequency and

duration of clinical features at the time of acute human

immunodeficiency virus type 1 (HIV-1) disease in 218 patients

with documented symptomatic primary HIV-1 infection. The mean

duration of acute HIV-1 disease was 25.1 days (median, 20.0

days) and did not differ by gender, age, and risk factor. The

frequency and mean duration of clinical features occurring in

>50% of patients were as follows: fever, 77.1% and 16.9 days;

lethargy, 65.6% and 23.7 days; cutaneous rash, 56.4% and 15

days; myalgia, 54.6% and 17.7 days; and headache, 50.9% and

25.8 days. Only 15.6% of patients presented with a typical

mononucleosis-like illness (MLI) defined as fever, pharyngitis

or sore throat, and cervical adenopathy, and 10% had no

features of an MLI. A meningitis-like syndrome occurred in 20

patients (9.2%). Acute HIV-1 disease is more diverse than

previously reported, and the absence of fever or other MLI

features does not rule out acute HIV-1 disease.

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