What Are the Early Signs of HIV?

Identifying the Signs Ensures Early Care and Treatment

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Question: What are the early signs of an HIV infection?

Answer: In the early stages of infection, many people will develop little or no signs of illness. This is, perhaps, one of the reasons why 20 percent of the 1.2 million Americans living with HIV go undiagnosed. They either don't realize they've been infected or will only act when outward signs begin to appear.

However, as many as 40 percent of cases, flu-like symptoms will develop within 7 to 14 days of an exposure.

This condition is commonly referred to as acute retroviral syndrome, or ARS (alternately known as acute seroconversion syndrome or seroconversion illness).

ARS can often present with the following symptoms, ranging from mild to severe:

  • fever
  • fatigue
  • headache
  • pharyngitis (sore throat)
  • myalgia (muscular aches and pain)
  • arthralgia (joint pain)
  • lymphadenopathy (swollen lymph glands)

Occasionally, these symptoms will be accompanied by a rash (popularly referred to as an HIV rash) which manifests with pink-to-red bumps that converge into larger patches, primarily on the upper half of the body. Moreover, 30 percent of individuals will experience short-term nausea, diarrhea, or vomiting.

Most of these symptoms are a result of the body’s response to HIV as it rapidly spreads from the site of infection to lymph tissue, triggering an inflammatory response.

ARS can persist for months until such time as the immune system begins to take control of virus and moves into what we call the chronic (persistent) stage o infection.

While HIV will still be replicating during later stage infection, it generally does so at a slower level until the HIV viral load is finally stabilized and a viral set point is established.

Confirming an HIV Infection

ARS can be missed even by doctor because the symptoms are often so flu-like in their presentation.

It is, therefore, important to understand how HIV is transmitted; to recognize the acute symptoms of HIV;, and to get an HIV test should you suspect you have been infected.

Since an HIV test can often deliver a negative or indeterminate result during the early stages of infection, an HIV viral load test can be used if symptoms are suggestive of ARS. In such case, if the person has a negative or indeterminate antibody result but a high viral load (over 100,000 copies/mL), he or she would be considered HIV-positive. Treatment would ideally begin immediately, while a follow-up test would be performed at a later date to confirm the results. 

Newer combination antibody/antigen assays have also proven highly effective in confirming serostatus during ARS, with some of the test displaying extremely high levels of accuracy.

As a result of this, the U.S. Preventive Services Task Force issued updated recommendations in May 2013 calling for the testing of all Americans ages 15 to 65 as part of a routine doctor visit. Others at higher risk for infection &8218# including sexually active men who have sex with men (MSM) — should be tested annually.

Benefits of Early Detection

Recognizing the symptoms of ARS is important as it affords a person the opportunity for early detection.

This not only helps ensure that HIV is not spread to others but offers benefits in the way of early treatment.

Studies indicate that the early initiation of antiretroviral therapy correlates to a reduced risk of both HIV-related and AIDS-defining illnesses. By contrast, delaying therapy until a person’s CD4 count drops below 350 cells/mL is associated with not only more adverse clinical events, but a significant — and even profound — reduction in life years.

Ultimately, early treatment prevents the depletion of CD4 cells central to the immune response. It can also reduce the risk of passing the virus to others by lowering the infected person's viral load, a strategy popularly referred to as Treatment as Protection (TasP).

It is now recommended that HIV therapy be started at the time of diagnosis, the practice of which is known to reduce the likelihood of illness and death by 57%.

Sources:

Cohen, M.; Gay, C.; Busch, P.; and Hecht, F. "The Detection of Acute HIV Infection." The Journal of Infectious Diseases. 2010; 202(Supplement2):S270-S277.

Hogg, R.; Althoff, K.; Samji, H.; et al. "Increases in life expectancy among treated HIV-positive individuals in the United States and Canada, 2000-2007." 7th International AIDS Society (IAS) Conference on Pathogenesis, Treatment and Prevention. Kuala Lumpur, Malaysia. June 30-July 3, 2013; Abstract TUPE260.

Moyer, V. "Screening for HIV: U.S. Preventive Services Task Force Recommendation Statement." April 30, 2013. Annals of Internal Medicine. April 30, 2013; doi:10.7326/0003-4819-159-1-201307020-00645.

Heinrich, T. and Gandhi, R. "Early Treatment and HIV Reservoirs: A Stitch in Time?" The Journal of Infectious Diseases. July 2013; doi: 10.1093/infdis/jit307.

The INSIGHT START Study Group. "Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection." New England Journal of Medicine. July 20, 2015; DOI: 10.1056/NEJMoa1506816.

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