Acute HIV infection Health Article

Definition

Acute HIV infection is caused by the human immunodeficiency virus (HIV), a virus that gradually destroys the immune system.

Alternative Names

Primary HIV infection; HIV seroconversion syndrome; Acute retroviral syndrome

Causes, incidence, and risk factors

Primary or acute HIV infection is a condition that occurs 2 - 4 weeks after infection with the human immunodeficiency virus (HIV). The virus is spread by:

• Breastfeeding (rarely)
• Contaminated blood transfusions and blood products
• Intravenous (IV) drug use with contaminated needles and syringes
• Passing through the placenta from the mother to the fetus
• Sexual contact

After someone is infected with HIV, tests can detect antibodies to the virus in the blood. This is called HIV seroconversion (converting from HIV negative to HIV positive), and usually occurs within 3 months of exposure, but on rare occasions can occur up to a year after exposure.

Following the acute infection, there may be no further evidence of illness for the next 10 years.

Acute HIV infection can, but does not always, progress to early symptomatic HIV infection and to advanced HIV disease (AIDS).

Not all people infected with HIV will necessarily progress to AIDS, but time has shown that the vast majority do. To date there are a small number of people who have tested positive for HIV, but later no longer test positive and have no signs of disease. Although this is relatively rare, it provides evidence that the human body may be capable of removing the disease. These people are being carefully watched and studied.

HIV has spread throughout the United States and other countries. Higher numbers of people with the disease are found in large metropolitan centers, inner cities, and among certain populations with high-risk behaviors.

Symptoms

Note: At the time of diagnosis with HIV, many people have not experienced any symptoms.

Acute HIV infection can appear like infectious mononucleosis, flu, or other viral illnesses.

Any of the following symptoms can occur:

• Decreased appetite
• Fatigue
• Fever
• Headache
• Malaise
• Swollen lymph glands
• Muscle stiffness or aching
• Rash
• Sore throat
• Ulcers of the mouth and esophagus

These symptoms can last from a few days to 4 weeks, and then subside.

Signs and tests

• Blood differential may show abnormalities.
• HIV ELISA/Western blot is usually negative or undetermined during the acute infection and will become positive over the next 3 months.
• HIV RNA viral load is positive in patients with acute HIV infection.
• Lower-than-normal CD4 count may indicate suppression of the immune system. The CD4 count usually improves 1 - 2 months after acute infection.
• P24 antigen blood test is often positive.

Treatment

People with HIV infection need to be educated about the disease and its treatment so they can be active partners in making decisions with their health care provider.

There is still controversy about whether aggressive early treatment of HIV infection with HIV medications will slow the progression of disease. You should discuss this option with your health care provider.

Follow these healthy practices in the early stages of HIV infection:

• Avoid exposure to people with acute infectious illnesses.
• Avoid settings and situations that could lead to depression. Maintain positive social contacts, hobbies, interests, and pets.
• Eat a nutritious diet with enough calories.
• Get enough exercise, but don't wear yourself out.
• Keep stress to a minimum.
• Practice safer sex. The disease is highly transmissible, especially in the first months after infection.

Support Groups

You can often reduce the stress of illness by joining a support group where members share common experiences and problems. See AIDS - support group.

Expectations (prognosis)

HIV is a long-term medical condition that can be treated but not yet cured. There are effective means of preventing complications and delaying (but not preventing) progression to AIDS. At the present time, not all cases of HIV have progressed to AIDS, but time has shown that the vast majority do.

Complications

• AIDS (acquired immune deficiency syndrome)
• Autoimmune diseases
• Cancers, typically Kaposi's sarcoma and lymphomas
• Opportunistic infections (unlikely to occur in early stages of HIV disease)
  • Bacillary angiomatosis
  • Candidiasis
  • Cryptosporidium or other protozoal enterocolitis
  • Cytomegalovirus infection
  • Pneumocystis carinii pneumonia
  • Mycobacterium avium complex (MAC)
  • Progressive multifocal leukoencephalopathy
  • Salmonella infection of the bloodstream
  • Toxoplasmosis
  • Tuberculosis

Calling your health care provider

Call for an appointment with your health care provider if you have had a possible or actual exposure to AIDS or HIV infection; or if you are at risk and have had symptoms like those of acute HIV infection.