Most of us are used to thinking of disease in very simple terms: if you feel sick, you are sick; if you feel healthy, you are healthy. However, because HIV may be causing subtle changes in the immune system long before an infected person feels sick, most doctors have adopted the term "HIV Disease" to cover the entire HIV spectrum, from initial infection to full-blown AIDS (which can also be called "Advanced HIV Disease").
The continuum that follows and its stages are representative of the experience of many people with HIV. The time that it takes for each individual person to go through these stages is varied. For most people, however, the process of HIV disease is fairly slow, taking several years from infection to the development of severe immunodeficiency.
HIV enters the bloodstream and begins to take up residence in the cells. People with HIV are considered to be infectious immediately after infection with the virus. Although some studies suggest that the level of infectivity varies over time depending on the stage of the disease in which the person is, it is not possible for most HIV-infected people to find out what their level of infectivity is.
A person with HIV is infectious at all times. Also, a person does not need to have symptoms or look sick to have HIV. In fact, people may look perfectly healthy for many years despite the fact that they have HIV in their bodies. The only way to find out if a person is infected is by taking an HIV antibody test.
Primary HIV infection is the first stage of HIV disease, when the virus first establishes itself in the body. Some researchers use the term acute HIV infection to describe the period of time between when a person is first infected with HIV and when antibodies against the virus are produced by the body (usually 6- 12 weeks). Within the first 72 hours after exposure, postexposure prevention (PEP) may be possible.
More than half of people newly infected with HIV will experience some "flu-like" symptoms for 1-3 weeks. These symptoms might include fevers, sore throat, swollen lymph nodes, skin rash, muscle aches, nausea or a general feeling of fatigue and malaise (not cold-like symptoms). Some people, however, have no symptoms when they first become infected with HIV -- or symptoms so mild that they may not notice them -- and others feel ill for much longer.
Given the general character of the symptoms of acute infection, they can easily have causes other than HIV, such as a flu infection. For example, if you had some risk for HIV a few days ago and are now experiencing flu-like symptoms, it might be possible that HIV is responsible for the symptoms, but it is also possible that you have some other viral infection.
The important thing to do is call an AIDS hotline to discuss whether you were in a situation that put you at risk for HIV and whether you should consider taking an HIV test. Call the CDC National AIDS Hotline toll free at 800/342-AIDS.
During acute HIV infection, the virus makes its way to the lymph nodes, a process which is believed to take three to five days. Then HIV actively reproduces and releases new virus particles into the bloodstream. This burst of rapid HIV replication usually lasts about two months. People at this stage often have a very high HIV "viral load." However, people with acute HIV infection usually will not test HIV antibody positive, since it takes the body approximately one to three months to produce antibodies against HIV.
Scientists disagree about whether anti-HIV treatment is useful during primary HIV infection, and there is little information from clinical trials. Most HIV specialists believe that early highly active antiretroviral therapy (HAART) is useful, and that its benefits likely outweigh the disadvantages of no treatment.
Most doctors, are treating newly HIV-infected people with a combination of anti-HIV drugs. While many researchers are optimistic about early anti-HIV treatment, they are also concerned about drug side effects, long-term effects and the possibility of developing drug-resistant virus if people use powerful anti-HIV drugs before they become ill due to HIV disease.
Some researchers think that if HIV replication can be slowed down early in the course of disease, it will take longer before a person develops AIDS. Several studies have shown that low blood viral load levels in the early stages of HIV disease are associated with less severe illness and slower disease progression. Some even think that it might be possible to eradicate, or completely kill off HIV, if treatment is started very early. So far, though, complete HIV eradication has not occurred, and most doctors recommend that anti-HIV treatment should be continued indefinitely once it is started.
This term refers to the time when the body begins producing antibodies to the virus. About 90 to 95% of the people infected with HIV will develop antibodies within three months after infection. 95 to 99.9% of people will develop antibodies within six months after infection.
Most people develop antibodies within three months and some can take up to six months. People who get tested need to wait at least three months for the test. If their first result is negative, they should come back for a second test three months later.
The virus appears to slowly damage the immune system for a number of years after infection (perhaps because the body is able to keep it in check during this time). In most people, however, a faster decline of the immune system occurs at some point, and the virus rapidly replicates. This damage can be seen in blood tests, such as lowered T-cell counts, before any actual symptoms are experienced.
People who are HIV-positive should see a doctor to monitor their immune systems. By getting lab indicators (such as the viral load test) and observing how they are changing over time, they can get a better sense of whether HIV has already caused any damage to their immune systems. As mentioned above, a development in the last couple of years in the treatment of HIV disease is what doctors call "Early Intervention" or "Early Care." The principle behind this concept is that early rather than late medical care may give people better chances of survival and better quality of life. It is extremely important that people with HIV learn that they have to see a doctor even if they feel fine at the moment because the virus could be already damaging their immune systems.
Understanding that HIV Disease begins immediately after infection enables us to begin treating infected persons before symptoms appear. This important medical advance has significantly extended the lifespan -- and the hope -- of HIV-infected people.
Once the immune system is damaged, many people will begin to experience some mild symptoms (skin rashes, fatigue, slight weight loss, night sweats, thrush in the mouth, etc.). Most, though not all, will experience mild symptoms such as these before developing more serious illnesses. Although one's prognosis varies greatly depending on one's ability to access support, services and preventative treatment, it is generally believed that it takes the average person five to seven years to experience their first mild symptom.
These symptoms are not specific to AIDS. However, they should be of concern to people who have tested positive to HIV. Usually, symptoms occur when the virus has already caused considerable damage to the immune system. For that reason, people with HIV should not wait until symptoms appear to get medical treatment. Also, people with high risk for HIV should not wait to get symptoms to take the HIV-antibody test.
If you are a person with HIV experiencing any symptoms, we suggest that you have them checked by a health care worker.