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[09-15-00 14:39:49] PAGES PGT: OPIN

Cite as: 524 U. S. 624 (1998)

635

Opinion of the Court

AIDS 19, 24. Osmond, Classiﬁcation and Staging of HIV
Disease, in AIDS Knowledge Base 1.1–8; Saag, Clinical Spec-
trum of Human Immunodeﬁciency Virus Diseases, in AIDS:
Etiology 204.

The initial stage of HIV infection is known as acute
In a typical case, this stage
or primary HIV infection.
lasts three months. The virus concentrates in the blood.
The assault on the immune system is immediate. The vic-
tim suffers from a sudden and serious decline in the num-
ber of white blood cells. There is no latency period.
Mononucleosis-like symptoms often emerge between six days
and six weeks after infection, at times accompanied by fever,
headache, enlargement of the lymph nodes (lymphadenopa-
thy), muscle pain (myalgia), rash, lethargy, gastrointestinal
disorders, and neurological disorders. Usually these symp-
toms abate within 14 to 21 days. HIV antibodies appear
in the bloodstream within 3 weeks; circulating HIV can be
detected within 10 weeks. Carr & Cooper, Primary HIV
Infection, in Medical Management of AIDS 89–91; Cohen &
Volberding, Clinical Spectrum of HIV Disease,
in AIDS
Knowledge Base 4.1–7; Crowe & McGrath, Acute HIV Infec-
tion, in AIDS Knowledge Base 4.2–1 to 4.2–4; Saag, AIDS:
Etiology 204–205.

After the symptoms associated with the initial stage sub-
side, the disease enters what is referred to sometimes as its
asymptomatic phase. The term is a misnomer, in some re-
spects, for clinical features persist throughout,
including
lymphadenopathy, dermatological disorders, oral lesions, and
bacterial infections. Although it varies with each individ-
ual, in most instances this stage lasts from 7 to 11 years.
The virus now tends to concentrate in the lymph nodes,
though low levels of the virus continue to appear in the
blood. Cohen & Volberding, AIDS Knowledge Base 4.1–4,
4.1–8; Saag, AIDS: Etiology 205–206; Staprans & Feinberg,
Natural History and Immunopathogenesis of HIV–1 Disease,
It was once
in Medical Management of AIDS 29, 38.