The stages and symptoms of HIV disease

Primary Infection & seroconversion

Primary infection is the first stage of HIV disease, when the virus first establishes itself in the body (SFAF, 1998b). Two to four weeks after exposure to the virus, up to 87% of HIV-infected persons suffer flu-like symptoms for a few days, indicating that their immune systems are fighting the newly introduced HIV. This sickness is called acute HIV syndrome. Its symptoms include fevers, chills, headaches, night sweats, rashes, and swollen glands (Bradley Hare, 2004).

It usually takes 6-12 weeks for the immune system to produce antibodies to fight against the virus. This means that a newly infected person's blood may not test positive for HIV antibodies in the first few weeks after becoming infected. Newly infected people are highly contagious during primary infection because large quantities of HIV are present in their genital fluids (NIAID, 2003).

Seroconversion describes the time when the body begins producing antibodies to the virus. Most people develop antibodies within 3 months. Some people can take up to 6 months to develop antibodies to HIV (SFAF, 1998b).

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Chronic HIV infection (asymptomatic period)

After the primary infection, people with HIV then enter an asymptomatic period (that is, a time when they have no signs or symptoms of HIV disease). This period is also called clinical latency. The duration of people's asymptomatic period varies and is influenced by their overall health and immune system functioning.

How long does it take people to develop symptoms of HIV disease? There is no one answer to this question. Some people may develop symptoms within a few months, whereas others may not have symptoms for more than 10 years. The average person with HIV is symptom-free for 7–8 years. It is important to know that even in the absence of clinical symptoms, the virus continues to multiply, infecting and killing immune system cells.

Although people with HIV have no symptoms during the asymptomatic period, their immune systems are already suffering from the presence of HIV. The virus is actively multiplying, and infecting and killing immune system cells (NIAID, 2003). HIV levels (often referred to as plasma viral load) in the body of a person with HIV correlate with the rate of CD4+ cell decline (immune system decline). This means that the more HIV a person has in his or her body—that is, the higher the plasma viral load—the lower his or her number of health-protecting CD4+ cells. The more HIV levels increase and numbers of CD4+ cells decrease, the faster a person progresses to AIDS and death (NIAID, 2003).

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Mild symptoms

Once the immune system is damaged, many people will begin to experience some relatively mild symptoms that are not specific to HIV infection. These include:

• Swollen lymph nodes that persist for more than 3 months
• Fatigue
• Weight loss
• Frequent fevers and sweats
• Persistent or frequent yeast infections (oral and vaginal)
• Persistent skin rashes and flaky skin
• Pelvic inflammatory disease (PID) that does not respond to treatment
• Short-term memory loss
• Frequent or severe herpes infections with oral, genital, or anal sores
• Shingles (a nerve disease)

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Opportunistic diseases

Opportunistic infections are infections caused by bacteria, funguses, or viruses that may not cause illness in people with normal immune systems. In people with HIV, however, these disease-causing agents take the “opportunity” to flourish in the absence of a normal immune response. In people with HIV, these infections are often severe and sometimes fatal because of the person's compromised immune system.

A person is diagnosed with AIDS when they have a confirmed HIV infection plus one of 25 clinical conditions, primarily opportunistic infections, that do not normally affect healthy people (CDC, 2003a). These conditions include certain kinds of pneumonia and tuberculosis.

Discussion question: What happens during each of the following stages of HIV disease: Primary infection; Acute HIV syndrome; Serconversion; Clinical latency; Advanced HIV disease?

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