Severe illness associated with appearance of antibody to human immunodeficiency virus in an African

A case report is presented of severe illness associated with appearance of antibody to human immunodeficiency virus in an African. A previously healthy 35-year-old African man became ill in November 1984 (day 0) with vague malaise and fatigue. The next day he developed joint pains and a fever of 39 degrees Centigrade which persisted over the next 13 days. Additional problems observed on the 2nd day included pharyngitis diarrhea and vomiting and a pruritic maculopapular rash on the face. By the 3rd day the rash extended to the trunk and occipital lymphadenopathy was noted. On day 4 shallow ulcers were observed on the palatal and gingival mucosa and on the penis and scrotum. During the next 5 days the patient became progressively obtunded to the extent that he was unable to speak or to recognize people. This state persisted until day 15 when all the patients symptoms dramatically improved. He was released from the hospital on day 19. Although the patients condition continued to improve during the 3 weeks following discharge from the hospital he developed generalized lymphadenopathy. Biopsy revealed nonspecific reactive hyperplasia. At his last visit at 14 months the patient was working full time and had regained all lost weight. The lymphadenopathy had gradually lessened from the end of the 4th month but was still present. The results of Western blot analyses and enzyme linked immunosorbent assay showed that antibody to HIV was present in the serum by day 11. From day 11 onward conincident with the development of antibodies lymphocytes (up to 10%) were consistently described as reactive. Results of liver function studies were abnormal during the 2nd week of illness. The patient did not know of any exposure to patients with the acquired immune deficiency syndrome or to needlesticks during the past year. He denied homosexuality and drug abuse and had never received a blood transfusion. The patient had not traveled outside of Kenya since 1982. During the year before his illness he had had many female sexual partners but no contact with prostitutes or venereal disease. No other report has documented the acquisition of antibodies in relation to clinical symptoms in similar detail. Antibody against p24 and p55 appeared earliest and before day 11 of illness coincident with the appearance of activated lymphocytes. Antienvelope protein antibodies p41 and gp120/160 were first detected faintly at day 16 coincident with clinical improvement. Antibodies against other antigens appeared before day 27 coincident with the development of persistent generalized lymphadenopathy. Thus severe symptoms may occur as a consequence of primary HIV infection.