The acute retroviral syndrome and the pathogenesis of HIV-1 infection

Semin Immunol. 1993 Jun;5(3):149-55. doi: 10.1006/smim.1993.1018.


The acute retroviral syndrome associated with primary HIV-1 infection is characterized by clinical signs of immune activation, multi-system dysfunction, and high levels of cell-associated and plasma viremia, p24 antigenemia, and proviral burden. Clinical abnormalities associated with acute HIV-1 infection and measures of viral burden and replication generally decline in concert with seroconversion. Despite clearance of virus, patients experiencing severe forms of the acute retroviral syndrome appear to have a poorer prognosis than patients with asymptomatic primary infection. This accelerated natural history may be due to the virulence of strains causing symptomatic infection, sequelae of initial high-titer viremia and consequent high viral burden, or immune depletion through immunopathologic mechanisms accelerated by strong antigenic stimulus in primary infection. Early intervention with anti-retroviral and immune modulatory agents has the potential to alter the natural history of patients with this syndrome.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Acute Disease
  • Cytopathogenic Effect, Viral
  • HIV Core Protein p24 / blood
  • HIV Infections / epidemiology
  • HIV Infections / immunology
  • HIV Infections / microbiology
  • HIV Infections / pathology*
  • HIV-1* / immunology
  • HIV-1* / isolation & purification
  • HIV-1* / pathogenicity
  • HIV-1* / physiology
  • Humans
  • Leukocytes, Mononuclear / microbiology
  • Prognosis
  • Proviruses / isolation & purification
  • Viremia / immunology
  • Viremia / mortality
  • Viremia / pathology*
  • Virulence
  • Virus Replication


  • HIV Core Protein p24