A high viral load indicates that there is a lot of HIV in the blood and other body secretions. In response to infection with HIV, the immune system produces antibodies against the virus. Unfortunately these antibodies fail to kill all the HIV. Acute seroconversion illness presents 2 to 6 weeks after infection with HIV.
During acute seroconversion illness the viral load is very high and the CD4 count may be temporarily depressed. The antibody screening tests for HIV may still be negative at the time of acute seroconversion illness, and only becomes positive a few weeks later. The above signs and symptoms are similar to those found in glandular fever infectious mononucleosis and therefore are not only present in HIV acute infection.
Yes, during the first few weeks of HIV infection, especially if the person develops seroconversion illness, large amounts of virus are present in the blood and other body fluids, and the person is very infectious to others. The immediate management of patients is symptomatic with antipyretics e. HIV infection and seroconversion are followed by a latent period when the person feels well. During this phase many people are not aware that they are HIV infected.
Although there are usually no, or few, clinical signs during the latent phase of HIV infection, generalised lymphadenopathy is common. During the latent phase the viral load is usually relatively low and the CD4 count is normal or only mildly depressed.
3. Body Weight and Body Shape Changes
When patients who have been clinically well during the latent asymptomatic phase of HIV infection become ill, they are said to have symptomatic HIV infection. The symptoms and signs of symptomatic HIV infection only present when the immune system is no longer able to protect the person from a wide range of viral, bacterial, fungal and parasitic infections opportunistic infections.
This only occurs when the immune system has been severely damaged. The level of virus in the blood viral load rises very rapidly within weeks of infection due to the extremely high rate of viral multiplication. This temporarily depresses the CD4 count. The production of antibodies increases in response to the HIV infection. Antibodies, together with CD4 cells, attempt to control the amount of virus in the body and the levels of HIV in the blood decreases. Eventually within 6 months a balance is reached between the production and destruction of HIV. This is known as the viral set point.
With the onset of symptomatic HIV infection constitutional symptoms the CD4 count starts to falls and the viral load increases and becomes very high with AIDS opportunistic infections. The level of virus in the blood is very high soon after infection and again with the development of AIDS. The progression of early to advanced HIV infection usually follows a recognisable pattern which depends on the degree of damage to the immune system.
Patients advance through stages 1 to 4 as their CD4 count falls. The clinical signs become worse and the CD4 count falls as patients progress from stage 1 to stage 4 HIV infection. Patients with stage 1 HIV infection are well and asymptomatic but almost all have persistent, generalised lymphadenopathy, especially in the neck, axilla and groin.
Acute seroconversion illness is also included in stage 1.
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- Infections Associated with AIDS?
Therefore, stage 1 starts at the time of infection. Patients with stage 2 HIV infection have repeated minor clinical problems. Skin rashes and minor mouth problems are very common. Patients with these early stages of HIV infection can usually continue their daily activity. Pulmonary TB and severe bacterial infections indicate stage 3 infection. These patients feel generally unwell and are no longer able to continue with their usual daily activities. Most of these patients will improve if their opportunistic infections are treated.
Marked weight loss continues and many patients are bedridden.
HIV Infection: Signs, Symptoms, and Complications
Severe opportunistic infections such as oesophageal candidiasis, extrapulmonary TB, pneumocystis pneumonia, cryptococcal meningitis and toxoplasmosis are common. Anaemia and malignancies associated with HIV infection are also common. Patients with stage 4 disease are regarded as having AIDS. Response to ART is usually good. Without treatment many will die within months. Severe wasting and dementia are common. Without treatment most patients rapidly die. A serious clinical condition which is very uncommon in HIV-negative people and yet seen commonly in patients with advanced HIV infection.
Common AIDS-defining infections include oesophageal candidiasis, and severe infections, such as meningitis, with pneumocystis, cryptococcus and toxoplasmosis. Severe oral infections which prevent the patient eating and drinking, and do not improve in a few days, may lead to further weight loss, dehydration and under-nutrition. These patients should be referred for specialist care. Many different skin rashes are seen in HIV-infected patients and a skin rash may be one of the earliest signs of a depressed immune system:.
Rashes may also be due to drugs used in ART e. Rashes are often severe, chronic or recurrent, and respond poorly to standard treatment. Rashes frequently are atypical and usually do not resolve spontaneously. Previous rashes may become worse with the development of HIV infection, e. With ART most rashes disappear.
It is difficult to treat and responds poorly to topical steroids and anti-itch agents. The rash slowly resolves with ART. Weight loss is severe and associated with chronic diarrhoea.
The patients feel weak and have fever. All patients with unexplained weight loss must be screened for HIV infection. Urgent ART is needed. Some forms of cancer occur more frequently in patients with AIDS. Viral infections and a damaged immune system are probably the cause.
Of interest is that only some cancers are more common in AIDS patients. However, the progression of other cancers common in the general population is more rapid in AIDS patients. Cancers more common in patients with AIDS are:. The mouth may also be involved, especially the hard palate. The patches and nodules often improve with ART.
What are early signs of HIV in men and women?
All patients with extensive skin lesions, oral lesions or signs of disseminated KS should be referred to a KS or specialist clinic within 2 weeks of starting ART. This is the second commonest cancer in AIDS patients. Therefore, early diagnosis and treatment are important. Lymphoma usually presents with large firm lymph nodes at 1 or more sites, or abdominal masses together with weight loss and unexplained fever. Sites other than lymph nodes can be involved, especially the brain, liver, bone marrow and gut.
Any patient with a suspected lymphoma must be referred for investigation and treatment. The prognosis is usually poor. Cervical cancer is common in women with AIDS. In the early stages there are usually no symptoms or signs. All authors: no conflicts. Google Scholar. Oxford University Press is a department of the University of Oxford.
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16 HIV Symptoms Every Woman Needs to Know
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Mkaya Mwamburi. Reprints or correspondence: Dr. Mkaya Mwamburi, Div. Oxford Academic. Ira B. Denise L. Donna Spiegelman. Sherwood L. Tamsin A.