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HIV is a viral infection that multiplies, infects and progressively gets rid of certain white blood cells. Read about the symptoms and stages of HIV.
What is HIV?
HIV (human immunodeficiency virus) is a viral infection that multiplies, infects and progressively gets rid of certain white blood cells in the immune system. Known as CD4+T cells, these warrior cells are a vital weapon in the immune system’s infection-fighting arsenal. When their numbers are depleted, the body’s defenses against infections and certain malignancies are weakened. HIV is a fast worker — as soon as it enters the body, it begins its attack on CD4+T cells. AIDS (acquired immunodeficiency syndrome) is the most advanced stage of an untreated HIV infection.
How can one contract HIV?
HIV is transmitted through close contact with a body fluid — such as blood, semen, vaginal fluids or breast milk — that contains either the virus or cells infected with the virus. Put simply, HIV can be spread through unprotected sexual contact (especially vaginal or anal sex); it enters the body through the lining of the vagina, vulva, penis, rectum or mouth during sexual contact. It can also be spread by sharing needles with an HIV-infected person. In addition, it can be spread to babies born to or breastfed by women infected with the virus. Blood transfusions with HIV-infected blood are now a rare means of acquiring HIV infection in the USA since all donated blood in the USA is rigorously tested for HIV.
Healthcare workers who are accidentally stuck with an HIV-infected needle have a very small chance — about 1 in 300 — of contracting HIV. Immediate treatment reduces this chance even further—to about 1 in 1500. In very rare instances, HIV can be acquired by blood from an infected person entering an open wound, a bite from an infected person, or the process of sharing razors or toothbrushes with an infected person.
It’s important to remember that HIV is not spread through casual contact, such as sharing food, utensils, phones, toilet seats, towels, bedding or swimming pools. Nor is it spread by shaking hands, hugging, or biting insects, such as mosquitos or bed bugs.
When and where can HIV testing be pursued?
Initially, people who have become infected with HIV have no symptoms. Blood tests that measure the presence and level of antibodies (disease-fighting proteins that the body produces in reaction to a virus) are the most common means of diagnosis. However, HIV antibodies usually don’t reach measurable levels until 1 to 3 months after infection. At times, it can even take up to 6 to 12 months to reach measurable antibody levels.
Although it’s best to be tested immediately if you think you may have been exposed to HIV, follow-up testing may be needed. If someone is extremely likely to have been infected with HIV but antibody tests are negative, a blood test for the presence of HIV itself is then used. The website HIV.gov has an HIV Testing Sites & Care Services Locator that you can use to find a testing site near you. In addition, most healthcare providers offer HIV testing.
Initial symptoms to track
Although many people don’t experience any symptoms when they first become infected with HIV (some may even be symptom-free for 10 years or more), others may have flu-like symptoms within a couple of weeks to a month post-infection that usually resolve within 7 to 10 days. This "flu-like" presentation is referred to as HIV sero-conversion syndrome. Even though blood tests may not show the presence of HIV antibodies, the infection can be present and is highly contagious at this time.
Listed below are symptoms of early HIV infection:
- Sore throat
- Swollen lymph nodes
- Sore muscles or joints
- Night sweats
- Mouth ulcers
However, it is imperative to remember that just because you have some of these symptoms, it does not mean you have HIV. Each of these symptoms can be caused by other illnesses. If you’re concerned that you may have been exposed to HIV, contact your doctor.
Developing symptoms to track
After the first symptoms go away, most people have only a few mild symptoms or even no symptoms at all. And that can last for 2 to 15 years for untreated HIV infection. During this stage—chronic HIV infection—the virus is still active but reproduces at very low levels. People who are receiving antiretroviral therapy (ART) may remain in this stage for decades. Although HIV can still be transmitted to others during this stage, people who are on ART are much less likely to transmit the infection or proceed to the next HIV stage. ART decreases the amount of HIV (viral load) in an infected person and prevents it from multiplying. The immune system is thus protected.
Below are the most common symptoms associated with this time period. Again, these symptoms don’t mean that you definitely have HIV because they each can be associated with other illnesses.
- Swollen lymph nodes
- Fever (sometimes with sweating)
- Shingles (more common in immunocompromised hosts)
- Progressive weight loss
- Thrush (a common fungal infection that causes white patches in the mouth and is caused by Candida, a yeast-like fungus)
Late-stage HIV symptoms
If HIV is present and remains untreated with ART, it will eventually weaken the body’s immune system and progress to the late stage of HIV infection, known as AIDS. Unfortunately, for some people, the first symptoms of HIV infection are those of AIDS and especially in resource poor countries where healthcare access is more difficult. People with AIDS have extremely low CD4+T counts (less than 200 cells/mm3) and are much more susceptible to acquire opportunistic infections and various cancers.
The symptoms associated with late stage HIV infection are listed below, but each of these symptoms can be caused by other illnesses.
- Rapid weight loss
- Extreme fatigue
- Recurring fever
- Profuse night sweats
- Diarrhea lasting more than 7 days
- Prolonged swelling of the lymph nodes in the armpits, neck or groin
- Sores of the mouth or genitals
- Red, brown, pink or purplish blotches on or under the skin or inside the mouth, nose or eyelids
- Memory loss
The importance of HIV testing
Early testing and diagnosis of HIV is crucial because it makes early treatment possible. Early detection allows for many more treatment options. Although there is currently no cure for HIV, there are medications that can slow down the rate at which the infection weakens the immune system and that may keep the infection in check. Beginning treatment as early as possible makes HIV transmission to other people less likely. Post-exposure prophylaxis (PEP) is available for those who think they may have been exposed to HIV within the previous 3 days. It can prevent HIV but must be started within 72 hours. And for those whose test results show them to be HIV-negative, there are HIV prevention options, such as pre-exposure prophylaxis (PrEP) that can help them remain negative.
If you think you may have been exposed to HIV, it’s important to be tested so that treatment can be started early and so that others do not become infected through contact with you. If you find that you’re experiencing some of the symptoms associated with HIV, it’s best to seek medical help and HIV testing as soon as possible.
[NOTE: ACCORDING TO THE NIH & CDC & PUBLISHED PEER REVIEW JOURNAL ARTICLES, IT IS VITAL TO BE TESTED AS SOON AS POSSIBLE---WHICH MEANS BEFORE SYMPTOMS APPEAR. HIV IS HIGHLY TRANSMISSABLE DURING THE EARLY PERIOD WHEN MANY INFECTED INDIVIDUALS HAVE NO SYMPTOMS. INDIVIDUALS SHOULD NOT WAIT UNTIL THEY HAVE SYMPTOMS TO BE TESTED; TREATMENT IS NOT AS EFFECTIVE & THE LIKELIHOOD THAT OTHERS MAY HAVE BEEN INFECTED DURING THE EARLY (AND OFTEN SYMPTOM-FREE) STAGE IS HIGH. THUS, IT CANNOT BE STATED THAT THERE EXISTS A COMBINATION OF SYMPTOMS THAT SHOULD LEAD AN INDIVIDUAL TO PURSUE HIV TESTING. GUIDELINES DO NOT SUPPORT THIS APPROACH BUT RATHER EMPHASIZE THE CRUCIAL IMPORTANCE OF EARLY TESTING BEFORE SYMPTOMS APPEAR, NOT AFTER SYMPTOMS APPEAR IF INDIVIDUALS THINK THEY MAY HAVE BEEN EXPOSED TO HIV.]
Dr. Rothschild has been a faculty member at Brigham and Women’s Hospital where he is an Associate Professor of Medicine at Harvard Medical School. He currently practices as a hospitalist at Newton Wellesley Hospital. In 1978, Dr. Rothschild received his MD at the Medical College of Wisconsin and trained in internal medicine followed by a fellowship in critical care medicine. He also received an MPH in 1998 from the University of Pittsburgh School of Public Health. Dr. Rothschild was a health services researcher at Brigham and Women with a focus on patient safety, quality improvement and information technology. More recently he was the Clinical Device Director for Partners Healthcare System integrating biomedical devices and physiologic monitors with the enterprise electronic health record.