HIV infection - asymptomatic
Key points
- Asymptomatic HIV infection is a phase during chronic infection with HIV (human immunodeficiency virus) during which there are no symptoms of HIV infection.
- Asymptomatic HIV infection is a period of varying length in which there is slow deterioration of the immune system without clinical 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).
- The diagnosis of HIV infection is based on standard blood tests, such as the HIV antibody test ELISA - followed by a confirmatory Western blot.
Alternative names
Asymptomatic HIV infection
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.
Written and revised by
Gerald Hurowitz, M.D.
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