In order to elucidate the time when HIV was introduced into a population of patients with acute hepatitis B, serum samples collected in the period 1975-1984 from 331 patients with hepatitis B were analysed for the presence of antibody to HIV (anti-HIV). Anti-HIV was not detected in any of the serum samples from 97 females. 5/234 serum samples from males (2%) were repeatedly positive. Anti-HIV was first demonstrated in 1978, 3 years before the first patients with AIDS were recognized in Denmark. None of the 4 Danish patients with anti-HIV developed AIDS during a follow-up period of 1-7 years. However, at the time of follow-up in 1985 3 had decreased cell mediated immunity. The hepatitis B infection had an uncomplicated course in 4/5 patients with anti-HIV. One patient had a protracted delta hepatitis and was a HBsAg carrier before as well as after the acute hepatitis. Thus, the HIV infection did not cause any complicated course in this study.
OBJECTIVE--To investigate the impact of the clinical course of the primary HIV infection on the subsequent course of the infection. DESIGN--Prospective documenting of seroconversion, follow up at six month intervals, and analysis of disease progression by life tables. PATIENTS--86 Men in whom seroconversion occurred within 12 months. PRIMARY OUTCOME MEASURE--Progression of HIV infection, defined as CD4 lymphocyte count less than 0.5 X 10(9)/l, recurrence of HIV antigenaemia, or progression to Centers for Disease Control group IV. MAIN RESULTS--Median follow up was 670 (range 45-1506) days. An acute illness like glandular fever occurred in 46 (53%) subjects. Three year progression rates to Centers for Disease Control group IV was 78% at three years for those who had longlasting illnesses (duration greater than or equal to 14 days) during seroconversion as compared with 10% for those who were free of symptoms or had mild illness. All six patients who developed AIDS had had longlasting primary illnesses. Three year progression rates to a CD4 lymphocyte count less than 0.5 X 10(9)/l and to recurrence of HIV antigenaemia were significantly higher for those who had longlasting primary illnesses than those who had no symptoms or mild illness (75% v 42% and 55% v 14%, respectively). CONCLUSION--The course of primary infection may determine the subsequent course of the infection.
One hundred and thirty-three homosexual men seropositive for the antibody against human immunodeficiency virus (HIV) were enrolled in a prospective study in 1984-85. The 3-year cumulative incidences of the acquired immunodeficiency syndrome (AIDS) and AIDS-related conditions, by life-table analyses, were 18% and 34%. The cumulative incidence of immune deficiency defined as CD4 lymphocytes less than 0.5 x 10(9) l-1 was 70% at 3 years. Absence of antibodies to p24 antigen, HIV antigenaemia, CD4 lymphocytes less than 0.3 x 10 l-1 and elevated serum level of IgA were significantly associated with the development of AIDS. There was no association between disease progression and persistent generalized lymphadenopathy. When adjusted to the probable year of infection, these results are in accordance with previous cohort studies. It is concluded that most, or all, subjects seropositive for HIV will develop progressive loss of CD4 lymphocytes followed by clinical signs of immune deficiency, and that differences among previous cohorts with respect to disease progression are probably due to differences in the duration of infection.
During 11 months from July 1993 to May 1994 the Department of Internal Medicine at Esbjerg Centralsygehus saw 19 patients with acute hepatitis A, B and/or C. In a normal year one to three patients are admitted with acute viral hepatitis. Sixteen of the patients reported intravenous drug use, half of them only sporadically, i.e. once or twice a month. Acute hepatitis A, B and C were seen in seven different combinations, the most frequent being acute hepatitis B in a hepatitis C antibody positive patient. The occurrence of acute hepatitis A in this group of patients may be due to parenteral transmission. Among 10 patients tested for HIV antibodies, none were found to be positive. In Esbjerg, which is the fifth largest city in Denmark, an automat with clean needles and syringes was installed six months after the culmination of the epidemic.
Over the nine month period from 1st July 1984 to 1st April 1985, 737 persons attended the four AIDS-screening clinics in Copenhagen. The attendance was unconditional, and the examination free of charge. All were examined clinically and serologically for LAV/HTLV-III infection. Ninety-seven percent were males; 490 (68%) and 198 (28%) described themselves as homosexual or bisexual respectively. This study presents epidemiological data on that group. As in other studies, we found a relationship between anti-LAV/HTLV-III and male homosexual promiscuity, i.e. trends towards higher antibody prevalences, the higher the number of different sexual partners annually and the number of previous sexually transmissible diseases. The occurrence of 18 percent seropositivity in a group with no previous sexually transmissible disease indicate a dissemination of the infection to a subpopulation of Danish homosexuals with a nonpromiscuous lifestyle. Night sweats and lymph node enlargement as subjective complaints along with lymphadenopathy and anal pathology on objective examination were significantly (p less than 0.025) related to positive LAV/HTLV-III serology. Fifty-one percent (337 persons) had neither subjective symptoms nor objective signs, and 50 of these (28% of this asymptomatic group) were seropositive. At this stage of the AIDS epidemic, it is important for surveillance purposes that anti-LAV/HTLV-III testing is made available to all members of risk groups. The establishment of the screening clinics with unconditional attendance and ensured anonymity seems to be an important step in this effort.