Primary human immunodeficiency virus type 1 infection: Clinical manifestations among women in Mombasa, Kenya

The occurrence of clinical manifestations associated with primary human imm unodeficiency virus type 1 (HIV-1) infection was evaluated in a prospective cohort study of female sex workers in Mombasa, Kenya, Among 103 women who seroconverted to HIV-1, fever, vomiting, diarrhea, headache, arthralgia, my algia, skin rash, swollen lymph nodes, extrainguinal lymphadenopathy, ingui nal lymphadenopathy, and vaginal candidiasis were noted significantly more frequently at visits in which seroconversion first became evident. Eighty-o ne percent of seroconverting women had greater than or equal to 1 of these II symptoms or signs. Among 44% of the women, the acute illness was severe enough to prevent them from working. Having greater than or equal to 2 of 6 selected symptoms and signs yielded a sensitivity of 51%, specificity of 8 3%, positive likelihood ratio of 3.2, and negative likelihood ratio of 0.5 for acute HIV-1 infection. The recognition of primary HIV-1-infection illne ss in high-risk populations and subsequent risk-reduction counseling could potentially reduce secondary HIV-1 transmission during this highly infectio us period.