title: Clinical characteristics and prognostic value of acute retroviral syndrome among injecting drug users. Italian Seroconversion Study.
abstract: OBJECTIVE
  To estimate the frequency of acute retroviral syndrome associated with HIV infection among injecting drug users (IDU), and to determine the extent to which acute retroviral syndrome predicts a faster rate of progression to AIDS and immunosuppression in this population.
  
  
  METHODS
  Prospective study of HIV seroconverters (median follow-up, 50.5 months).
  
  
  METHODS
  Sixteen clinical centres throughout Italy established to study the natural history of HIV infection.
  
  
  METHODS
  Three hundred and ninety-one IDU for whom the date of HIV seroconversion was established with a 9-month precision.
  
  
  METHODS
  Incidence of acute retroviral syndrome with signs and symptoms that included fever (temperature > 38 degrees C) occurring within 6 months prior to the time of first positive HIV test, progression to AIDS, crude and adjusted relative hazard of AIDS using survival analysis techniques, and trajectories of CD4+ cell counts using a piece-wise linear regression model incorporating the degree of dependency of within-person measurements.
  
  
  RESULTS
  Of 391 HIV seroconverters, 39 (10.0%) were diagnosed with acute retroviral syndrome. During follow-up, 13 seroconverters with acute retroviral syndrome and 24 asymptomatic seroconverters developed AIDS. The Kaplan-Meier estimates for the cumulative AIDS incidence during 4.5 years of follow-up were 26.8 and 6.5%, respectively; the relative hazard of developing AIDS for acute retroviral syndrome was 5.59 (95% confidence interval, 2.79-11.20) after adjustment for age, sex and year of seroconversion. Although CD4+ level within the first year from seroconversion was similar, the rate of CD4+ cell decline after 1 year from seroconversion was faster in individuals with acute retroviral syndrome than in those without this syndrome (P < 0.001).
  
  
  CONCLUSIONS
  Among HIV-infected IDU, a distinct acute retroviral syndrome is apparent and associated with a faster rate of clinical progression to AIDS and HIV-related immunosuppression.
authors.affiliation: Laboratory of Epidemiology and Biostatistics, National Institute of Health, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Dorrucci
authors.forename: G
authors.initials: G
authors.lastname: Rezza
authors.forename: D
authors.initials: D
authors.lastname: Vlahov
authors.forename: P
authors.initials: P
authors.lastname: Pezzotti
authors.forename: A
authors.initials: A
authors.lastname: Sinicco
authors.forename: A
authors.initials: A
authors.lastname: Nicolosi
authors.forename: A
authors.initials: A
authors.lastname: Lazzarin
authors.forename: N
authors.initials: N
authors.lastname: Galai
authors.forename: S
authors.initials: S
authors.lastname: Gafà
authors.forename: R
authors.initials: R
authors.lastname: Pristerà
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000209:etiology* / Q000276:immunology; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D016655:HIV Core Protein p24 / Q000032:analysis; D006679:HIV Seropositivity; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D015819:Substance Abuse, Intravenous / Q000150:complications*; D013577:Syndrome
chemical_list: D016655:HIV Core Protein p24