Asymptomatic HIV infection

Alternative names
HIV infection - asymptomatic

Definition
Asymptomatic HIV infection is a phase during chronic infection with HIV (human immunodeficiency virus) during which there are no symptoms of HIV infection.

Causes, incidence, and risk factors

Asymptomatic HIV infection is a period of varying length in which there is slow deterioration of the immune system without clinical symptoms. There is frequently a decline in the CD4 counts, an index of immune function.

The length of this phase is highly variable among individuals and correlates with the level of replication of HIV in each individual, as well as genetic differences in the way the immune system handles the virus.

In some individuals, the asymptomatic phase can last 10 years or longer, while in others, clinical symptoms and worsening immune function may occur within a few years from the time of original infection.

Symptoms

Asymptomatic HIV infection is, by definition, characterized by the absence of symptoms associated with HIV, such as fevers, weight loss, oral thrush, or any opportunistic infections (such as with Pneumocystis carinii pneumonia, cytomegalovirus, and Mycobacterium avium).

Signs and tests
The diagnosis of HIV infection is based on standard blood tests, such as the HIV antibody test ELISA - followed by a confirmatory Western blot.

Treatment

The timing of antiretroviral therapy for asymptomatic individuals is controversial. All asymptomatic individuals with CD4 counts of less than 200 should be on therapy.

Many experts would also treat individuals with CD4 counts between 200 and 350. In the case of asymptomatic individuals with a CD4 count greater than 350, some would recommend therapy, especially if the HIV viral load is elevated (greater than 55,000 by RT-PCR or 30,000 by bDNA). However, this is a subject of debate.

Additional factors, such as patient readiness and the ability to adhere to therapy, must be taken into consideration before initiating antiretroviral therapy.

Support Groups

The stress of illness can often be helped by joining a support group where members share common experiences and problems. See AIDS - support group.

Expectations (prognosis)

HIV is a chronic medical condition that can be treated, but not cured. The availability of combination antiretroviral therapy has significantly delayed the progression to AIDS and decreased the incidence of AIDS-related opportunistic infections.

Complications

Individuals with asymptomatic infection may progress to symptomatic HIV infection and develop opportunistic infections associated with HIV. In addition, pregnant women with asymptomatic HIV infection may still transmit HIV to their fetus.

Calling your health care provider

Notify your health care provider if you have HIV and you develop fevers, weight loss, swollen glands, and/or night sweats, as you will need to be evaluated and antiretroviral therapy might need to be considered.

Prevention

Prevention of HIV infection relies primarily upon decreasing the risk of sexual transmission by safer sex behaviors, as well as avoiding contact with contaminated blood (ceasing injection drug use or not sharing needles or syringes, and proper screening of blood products).

Individuals at risk for HIV infection should undergo periodic testing to ensure early diagnosis of this infection, as there are numerous treatment options available.

Johns Hopkins patient information

Last revised: December 4, 2012
by Amalia K. Gagarina, M.S., R.D.

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