Primary HIV infection

Alternative names
Acute HIV infection; HIV seroconversion syndrome; Acute retroviral syndrome

Definition
Acute HIV infection is caused by the human immunodeficiency virus (HIV), a virus that gradually destroys the immune system.

Causes, incidence, and risk factors

Primary or acute HIV infection is a condition that occurs 2 to 4 weeks after infection by the HIV virus. The virus, called human immunodeficiency virus or HIV, is spread by intimate sexual contact, injection drug use in which contaminated needles and syringes are used, contaminated blood transfusions and blood products, through the placenta from the mother to the fetus, and rarely through breastfeeding.

Acute HIV infection can resemble infectious mononucleosis, flu, or other virual syndromes. Typical symptoms include fever, headache, fatigue, and swollen lymph nodes. People may also experience aching muscles and a rash that occurs anywhere on the body and may change locations. These symptoms may last from a few days to 4 weeks, and then subside.

After an infection with HIV, antibodies to the virus can be detected in the blood. This is called seroconversion. HIV seroconversion (converting from HIV negative to HIV positive) usually occurs within 3 months of exposure, but on rare occasions may occur up to a year after exposure.

Following the acute infection, there may be no further evidence of illness for the next decade.

Acute HIV infection can, but does not always, progress to early symptomatic HIV infection and to advanced HIV disease (AIDS).

It cannot be assumed that all people infected with HIV will inevitably progress to AIDS, but time has shown that the vast majority do. To date there are a small number of people who have unquestionably tested positive for HIV, but no longer test positive and have absolutely no signs of disease. These numbers are extremely small, but they provide evidence that the human body may be capable of eliminating the disease. These people are being carefully watched and studied.

HIV has spread throughout the United States and other countries. Higher concentrations of the disease are found in large metropolitan centers, inner cities, and among certain populations with high-risk behaviors.

Symptoms

Note: At the time of diagnosis with HIV, many people have not experienced any symptoms.

Any of the following symptoms may occur:

     
  • fever  
  • headache  
  • fatigue  
  • malaise  
  • decreased appetite  
  • swollen lymph glands  
  • muscular stiffness or aching  
  • generalized rash, usually flat to slightly raised (maculopapular) and red  
  • sore throat  
  • mouth and esophageal ulcers

Signs and tests

     
  • An HIV ELISA/Western blot is usually negative or indeterminate during the acute infection and will become positive over the next three months.  
  • An HIV RNA viral load is positive in patients with acute HIV infection.  
  • A CD4 count may show suppression of the immune system. The CD4 count usually improves 1 to 2 months following acute infection.  
  • A blood differential may show abnormalities.  
  • P24 antigen blood test is often positive

Treatment

People with HIV infection need to receive education about the disease and its treatment so they can be active partners in decision making with the health care provider. Recent studies show that aggressive early treatment of HIV infection with HIV medications can slow the progression of disease. You should discuss this option with your health care provider. Certain healthful practices should be followed in the early stages of HIV infection:

     
  • Stress should be kept to a minimum.  
  • Avoid exposure to people with acute infectious illnesses.  
  • Get adequate exercise, but don’t wear yourself out.  
  • Maintain a nutritious diet with adequate caloric intake.  
  • Avoid settings and situations that could lead to depression. Maintain positive social contacts, hobbies, interests, and pets.  
  • Practice safer sex. The disease is highly infectious in the first month after infection.

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

Expectations (prognosis)

HIV is a long-term medical condition that can be treated but not yet cured. There are effective means of preventing complications and delaying (but not preventing) progression to AIDS. At the present time, not all cases of HIV have progressed to AIDS, but time has shown that the vast majority do.

Complications

     
  • AIDS (acquired immune deficiency syndrome)  
  • opportunistic infections (unlikely to occur in early stages of HIV disease)       o pneumocystis carinii pneumonia       o candidiasis       o cytomegalovirus infection       o toxoplasmosis       o cryptosporidium enterocolitis  
  • malignancies, typically Kaposi’s sarcoma and lymphomas  
  • autoimmune diseases

Calling your health care provider

Call for an appointment with your health care provider if you have had a possible or actual exposure to AIDS or HIV infection; or if you are at risk and have had symptoms suggestive of acute HIV infection.

Prevention

For a comprehensive discussion, see the prevention section in AIDS.

Safer sex behaviors may reduce the risk of acquiring the infection. There is a risk of acquiring the infection even if “safe sex” is practiced. Abstinence is the only sure way to prevent sexual transmission of the HIV virus.

General guidelines:

     
  • Do not have sexual intercourse with persons known or suspected to be infected with AIDS, numerous partners, any person who has multiple partners, or people who use IV drugs.  
  • Do not use intravenous drugs. If IV drugs are used, do not share needles or syringes.  
  • People with AIDS or who have had positive HIV antibody tests may pass the disease on to others and should not donate blood, plasma, body organs, or sperm. Do not exchange body fluids (including saliva) during sexual activity.

Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.