Jul 4, 2005
In a a recent question in which a patient asked if symptoms during the acute HIV stage were an indication of disease progression, you stated that symptoms are not an indication, however the severity of the symptoms are. Does this mean that someone who had a very short duration of symptoms (or no symptoms at all) in the acute stage has a lower likelihood of faster progression than someone who became severely sick during acute retroviral syndrome?
Response from Dr. Conway
That is probably true. Insomuch as the symptoms reflect unopposed viral replication, they indicate that someone was exposed to more virus, more pathogenic virus and/or virus that the person's imune system is less able to control. All of these things suggest that the setpoint of viral load will be higher and there will be a higher risk of disease progression more rapidly. In some cases, though, the symptoms may be due to the immune system reacting to the virus, and this would be a good thing in terms of more effective control of the virus.
You can certainly use the information about symptoms to discuss the possibilities about disease progression with a recently infected individual, but it would be most important to confirm this with data about that person's viral load and CD4 count from the 6 month point onwards, as, for that person, that is what will predict disease progression, acute symptoms or not. It is just that the presence of symptoms is what will help predict how likely they are to achieve a more or less favorable set point.
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