October 15, 2012
About half of the people who get infected don't notice anything. Symptoms generally occur within 2 to 4 weeks. The most common symptoms are fever, fatigue, and rash. Others include headache, swollen lymph glands, sore throat, feeling achy, nausea, vomiting, diarrhea, and night sweats.
It is easy to overlook the signs of acute HIV infection. They can be caused by several different illnesses. If you have any of these symptoms and if there is any chance that you were recently exposed to HIV, talk to your health care provider about getting tested for HIV.
However, the viral load test (see Fact Sheet 125) measures the virus itself. Before the immune system produces antibodies to fight it, HIV multiplies rapidly. Therefore, this test will show a high viral load during acute infection.
A negative HIV antibody test and a very high viral load indicate recent HIV infection, most likely within the past two months. If both tests are positive, then HIV infection probably occurred a few months or longer before the tests. In June 2010 the FDA approved a new HIV test that detects both antibodies to HIV and HIV proteins. This new test should produce results faster than a test for antibodies alone.
Up to 60% of infection-fighting "memory" CD4 cells (see Fact Sheet 124) are infected during acute infection, and after 14 days of infection, up to half of all memory CD4 cells can be killed. Also, HIV quickly reduces the ability of the thymus gland to replace lost CD4 cells. The lining of the intestine -- an important part of the immune system -- also loses a significant number of CD4 cells within 4 to 6 weeks after infection. This can all occur before a person tests positive for HIV.
The risk of passing HIV infection through sexual activity is also much higher during the early stage of acute infection.
Guidelines for using HIV medications recommend waiting until the immune system shows signs of damage. However, starting ARVs during acute HIV infection might protect the HIV-specific immune response.
Researchers have studied people who start treatment during acute infection and then stop taking ARVs. One study showed that this treatment may delay the time until ART is needed. Researchers are doing more studies.
Taking ART changes your daily life. Missing doses of drugs makes it easier for the virus to develop resistance to medications, which limits future treatment options. Fact Sheet 405 has more information about the importance of taking ARVs correctly.
The medications are very strong. They have side effects that can be difficult to live with for a long time, and they can be very expensive.
Early treatment can protect the immune system from damage by HIV. Immune damage shows up as lower CD4 cell counts and higher viral loads. These are associated with higher rates of disease. Older people (over 40 years old) have weaker immune systems. They do not respond to ARVs as well as younger people.
However, not everyone with HIV gets sick right away. Someone with a CD4 cell count over 350 and a viral load under 20,000, even if they don't take ART, has about a 50/50 chance of staying healthy for 6 to 9 years.
At first, researchers believed that early treatment might allow a patient to stop taking ART after a period of controlling HIV. However, newer reports indicate that this is probably not true.
If you think you might be in the acute stage of HIV infection, tell your health care provider and get tested. Talk to your health care provider about the possible advantages of starting ART during acute HIV infection.
Taking ARVs is a major commitment. Discuss the pros and cons of treatment with your health care provider and consider them carefully before making any decisions.