Becoming HIV antibody positive

The earliest stage of HIV infection is called Primary HIV Infection (PHI) and, according to definition, lasts from for three to six months after infection. During this time the body is adjusting to the presence of HIV. It is a stage during which the immune system would successfully clear many other viral infections, but for reasons that are still not completely clear, the immune response it develops to HIV cannot do this.

During primary infection patients may have 10 to 100 times as much HIV in their body fluids as subsequently, which means they are a lot more infectious.

The majority of people (about 50-80%) have a short illness soon after they become infected. This is called 'seroconversion illness' because it coincides with the time that blood (‘serum’) tests for antibodies to HIV become positive. The illness may take the form of a sore throat, a fever or a rash, or, rarely, more severe illness. However a large minority of people have no symptoms, and seroconversion illness may be mistaken for other illnesses such as flu.

Seroconversion illness

Around the time antibodies to HIV are appearing in the blood, some people may develop symptoms following exposure to HIV. This is known as seroconversion illness. The symptoms, which are caused by the body’s immune response to the new infection, may include:

• Prolonged fever (4 – 14 days) and aching limbs
• Red blotchy rash over the trunk
• Sore throat (pharyngitis)
• Ulceration in the mouth or genitals
• Diarrhoea
• Severe headaches
• Aversion to the light.

Other symptoms, such as paralysis, meningitis and opportunistic infections as a consequence of severe immune suppression are much less common. Symptoms of seroconversion may occur in up to 80% of people infected, but the severity of the symptoms varies. Some people report only a mild flu–like illness 2 to 6 weeks after a risk of HIV exposure, but a few experience an illness severe enough to require hospitalisation. The longer the illness lasts, and the more severe it is, the more likely you would be to develop AIDS within five years, presuming you were not to use antiretroviral therapy.

Remember that these symptoms could be caused by other infections; flu, glandular fever, tonsillitis and a serious herpes attack have similar symptoms to those reported in seroconversion illness.

During recent years studies have been done to see if treating people during the early stages of HIV infection – before to shortly after seroconversion - would have the effect of slowing down or stopping the course of HIV infection and the eventual development of AIDS.

Recent trials, some of which are still ongoing, have disappointed hopes that early treatment might alter for the better the subsequent course of illness. There are also disadvantages to taking anti-HIV therapy from the start such as experiencing drug side effects, and possibly risking developing drug-resistant HIV, before it is necessary to do so. At present the British HIV Association (BHIVA) does not recommend that patients diagnosed during PHI routinely take anti-HIV therapy, but does say patients should be offered the choice to take part in of the ongoing trials of early treatment.   

Asymptomatic HIV infection

Initially any damage caused by HIV has no outward effect. This is called asymptomatic infection, which may last for many months or years.

Sometimes people with asymptomatic HIV infection may have swollen lymph nodes, which is called PGL, Persistent Generalised Lymphadenopathy. But this is not a sign of damage in itself.

People who have HIV and feel 100% well may nevertheless have signs of immune damage detectable by laboratory tests; for example, their CD4 count may be below normal levels. Viral load tests have also demonstrated that HIV is actively replicating inside the bodies of asymptomatic people from the moment of infection; at no time is the virus truly latent. The CD4 count and viral load are known as ‘surrogate markers’ and are discussed in the HIV & AIDS Treatments Directory.

Symptomatic HIV Infection

Statistical studies of people with HIV have shown that the more time passes, the more likely it is that the damage will become more severe and infections or tumours may develop. However, such statistics reflect population tendencies: individuals will have their own responses to HIV which may or may not lead to symptomatic disease.

The average time from HIV infection to the development of AIDS (in the absence of treatment) is usually quoted as 8-12 years. However this varies widely. Some people develop AIDS within a few years and a handful almost immediately. Equally, there are people who have had HIV for 20 years yet remain well and do not need to take treatment. Several different factors combine to influence the course of infection: the person’s genetic makeup, their body’s immune response to HIV, and the ‘fitness’ of their strain of HIV are all factors.

The infections are called opportunistic infections because they are infections with pathogens that are around us all the time – and which our immune systems can normally fight off with no problems. They only become a problem if the immune system is not working well, so that infections that were previously under control become reactivated.

Our bodies also contain cells that can start to divide uncontrollably at any given moment. Normally, these too are kept under control by our immune system. If, however, our immune system is damaged, these cells can cause opportunistic tumours or sometimes cancer.

In addition, HIV can have direct effects upon the body. For instance, the virus can also attack cells in the brain. These cells are involved in feeding the brain cells. If they are damaged, the brain, or some nerves, may not work as well as usual. This is called HIV-associated dementia.

When someone gets ill due to these infections or tumours, he or she is said to have symptomatic HIV infection.

It is important to understand that apart from the so–called 'wasting syndrome' and HIV-associated dementia, the symptoms of AIDS and of symptomatic HIV disease are the symptoms of particular conditions caused by opportunistic infections and tumours, and not directly by HIV itself. Therefore there is a wide range of possible symptoms, and it serves no particular function to answer the question: what are the symptoms of AIDS? Particular symptoms are associated with particular opportunistic infections.

An AIDS diagnosis

Before coming to a diagnosis of AIDS, doctors look at a variety of symptoms and tests. There is no single test for AIDS.

Doctors will look for one of the opportunistic infections or cancers in the presence of underlying immune deficiency. They might, for instance, do tests to try to seek a positive diagnosis of PCP, a type of pneumonia.

These tests are normally only available if you have already been diagnosed as HIV antibody positive, or sometimes if you are seriously ill.