SEVERE PRIMARY HIV-1 INFECTION AMONG BLACK PERSONS IN BARBADOS

Descriptions of primary HIV-1 infection have so far been based on Cauc asians living in industrialized nations. Due to studies of leptospiros is in the predominantly black population of Barbados, serum was availa ble for patients admitted with acute febrile illnesses to the Queen El izabeth Hospital (QEH). By searching the medical records of 510 adult patients with known HIV-1 infection we identified 10 patients who had stored serum from an admission for an acute febrile illness that preda ted or coincided with their first HIV-1-positive test. Serological tes ting confirmed primary HIV-1 infection in 9 and was suggestive in the 10th patient. The clinical features of these 10 patients were in keepi ng with previous descriptions of primary HIV-1 infection but differed from leptospirosis cases seen at the QEH. One patient died during his seroconversion illness and another died 3 months after seroconversion. The findings suggest that severe primary HIV-1 infection could be a r elatively uncommon occurrence, that the condition may be misdiagnosed, and that cases may not occur until the AIDS epidemic is established.