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Stages of HIV infection
Most people who become infected with HIV do not notice that they have been infected. Some have a short illness soon after they become infected. This is called 'seroconversion illness' because it coincides with the time that blood 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.
Seroconversion illness
Before the appearance of antibodies to HIV in the blood, some people may develop symptoms following exposure to HIV. Antibodies usually become detectable at the same time as this illness. This is known as seroconversion illness. The symptoms 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 others 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.
If you think that you have been exposed to HIV in recent weeks and you develop some of these symptoms, treatment is an option that should be considered. However, we don't yet know whether this treatment will be of long–term benefit. If you want to begin such treatment, you should approach one of the major HIV treatment centres immediately. Do not wait to be referred by your GP, who may not understand the urgency of the need for treatment or the scientific rationale for intervening with drug treatment at this stage of infection. Some of the largest GUM clinics in London are now running studies to follow people treated at this stage of infection. If you live outside London, call your local clinic and ask to speak to a consultant to find out whether they will consider embarking on an experimental course of treatment.
Current British HIV Association guidelines recommend that treatment in acute infection is best initiated as part of a clinical trial.
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. The use of viral load tests has 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 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 go out of control 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 immune 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 are 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.