THE SPECTRUM OF MEDICAL CONDITIONS AND SYMPTOMS BEFORE ACQUIRED-IMMUNODEFICIENCY-SYNDROME IN HOMOSEXUAL AND BISEXUAL MEN INFECTED WITH THE HUMAN-IMMUNODEFICIENCY-VIRUS

The full range and occurrence of medical conditions in persons infecte d with human immunodeficiency virus (HIV) before they develop illnesse s that define acquired immunodeficiency syndrome (AIDS) have not been systematically or completely described. In a retrospective and prospec tive cohort study, 1,073 homosexual and bisexual men in three US citie s were interviewed and examined twice per year from January 1988 to Se ptember 1992. Study participants were from San Francisco, California ( 273 HIV-seropositive and 432 HIV-seronegative men), Denver, Colorado ( 107 positive and 129 negative men), and Chicago, Illinois (54 positive and 78 negative men). A total of 305 HIV-positive men had specifiable dates of HIV seroconversion (mean of 15.3 months between the last neg ative and the first positive HIV antibody test). Besides much increase d incidences of thrush (incidence relative risk (IRR) = 23.3) and hair y leukoplakia (IRR = 551), the following conditions also occurred sign ificantly more frequently in HIV-positive men than in HIV-negative men : anal herpes (incidence density (ID) = 10.7/100 person-years; IRR = 7 .7); sinusitis requiring antibiotics (ID = 6.2/100 person-years; IRR = 2.1); anal warts (ID = 5.8/100 person-years; IRR = 2.7); seborrhea (I D = 3.8/100 person-years; IRR = 6.6); community-acquired pneumonia (ID = 1.4/100 person-years; IRR = 2.7); skin cancers (ID = 1.0/100 person -years; IRR = 2.2); and seizures, often apparently ''breaking through' ' prior anticonvulsant therapy (ID = 0.8/100 person-years; IRR = 5.6). First episodes of hairy leukoplakia, thrush, and skin cancer occurred at low mean CD4 counts (mean counts were less than 350 cells/mu l) an d late in HIV infection (mean times were more than 8 years after HIV s eroconversion). Many medical problems, some not widely appreciated, oc cur in HIV-infected men before they develop AIDS-defining illnesses, s ignifying considerable morbidity from pre-AIDS HIV infection.