HIV: Stages of HIV in the body

Stage 1: Primary infection (0-3 months)

 “Early” stage consists of 2 events:

• Window period
• Seroconversion

Window Period:

Primary HIV infection is the first stage of HIV disease, when the virus first establishes itself in the body.

Some researchers use the term acute HIV infection to describe the period of time between when a person is first infected with HIV and when antibodies against the virus are produced by the body (usually 2 – 12 weeks).

During this time the body is trying to fight the virus, and starts to make antibodies to help do this. The person looks healthy, and are usually symptom free.

At this time the virus is getting into the CD 4 cells, and making copies of itself and destroying the CD 4 cells.

Seroconversion

During the primary infection seroconversion occurs within the first 3 months after acquiring the infection and there may be a short (1-2 weeks) seroconversion illness at the time. In the first few years after HIV infection, the HIV antibody test may be the only sign of HIV infection.

Up to 70% of people newly infected with HIV will experience some “flu-like” symptoms.

These seroconversion illness symptoms, which usually last no more than a few days, might include fevers, chills, night sweats, sore throat, lymph glands may be swollen and skin rashes. The remaining 30% of people either do not experience any symptoms or have symptoms so mild that they may not notice them.

The person is highly infectious and can easily infect others at this stage

During acute HIV infection, the virus makes its way to the lymph nodes, a process which is believed to take three to five days.

HIV actively reproduces and releases new virus particles into the bloodstream.

This burst of rapid HIV replication usually lasts about two months.

People at this stage often have a very high HIV “viral load“ and are very infectious. The person still appears healthy despite the high viral load. This is however the time when they are highest risk to infect others.

People with acute HIV infection usually will not test HIV antibody positive, since it takes the body approximately one to three months to produce antibodies against HIV.

When the antibody levels are high enough and detected with the antibody test it is said that:

• Seroconversion has occurred where the blood (serum) has converted from being negative for HIV antibodies to being positive for HIV antibodies, using the antibody test.

Stage 2: Immune system deterioration (3 months – 8 years)

The virus appears to slowly damage the immune system for a number of years after infection (perhaps because the body is able to keep it in check during this time).

In most people, however, a faster deterioration of the immune system occurs at some point, and the virus rapidly replicates/ multiplies again.

This damage can be seen in baseline blood tests, such as lowered CD 4 T-cell counts, before any actual symptoms are experienced.

People who are HIV-positive should see a doctor to monitor their immune system.

By getting baseline blood tests and observing how they are changing over time, they can get a better sense of whether HIV has already caused any damage to their immune system.

A development in the last couple of years in the treatment of HIV disease is what doctor’s call “Early Intervention” or “Early Care.” A person is now started on ARV’s a soon as possible after being diagnosed, to prevent immune system deterioration.

Clinical Stage 2 – Symptoms during this time might include the following:

·Unexplained moderate weight loss (less than 10% of presumed or measured body weight)
·Papular pruritic eruptions
·Fungal nail infections
·Recurrent oral ulcerations
·Angular cheilitis
·Seborrhoeic dermatitis
·Herpes zoster
·Recurrent upper respiratory tract infections (i.e bacterial sinusitis, tonsillitis, otitis media, pharyngitis)

Clinical stage 3 – symptoms during this time might include:

·Weight loss, >10% of body weight
·Unexplained chronic diarrhoea, >1 month
·Unexplained prolonged fever (above 37.5°C intermittent or constant) > 1 month
·Persistent oral candidiasis (thrush)
·Oral hairy leukoplakia
·Pulmonary tuberculosis, within the past year
·Severe bacterial infections (e.g. pneumonia, empyema, pyomyositis, bone or joint infection, meningitis, bacteraemia)
·Acute necrotising ulcerative stomatitis, gingivitis or periodontitis
·Unexplained anaemia (<8.g/dl), neutropaenia (<0.5 x 109 per litre) and/or chronic thrombocytopaenia.
And/or performance scale 3: bedridden, <50% of the day during the last month

Clinical Stage 4  – symptoms might include:

·HIV wasting syndrome
·Pneumocystic Jeroveci pneumonia
·Toxoplasmosis of the brain
·Cryptosporidiosis with diarrhoea, >1 month
·Cryptococcosis, extra-pulmonary
·Cytomegalovirus (CMV) disease of an organ other than liver, spleen or lymph nodes
·Herpes simplex virus (HSV) infection-chronic, mucocutaneous >1 month, or visceral any duration
·Progressive multifocal leukoencephalopathy (PML)
·Any disseminated endemic mycosis (i.e histoplasmosis, coccidiomycosis)
·Candidiasis of the oesophagus, trachea, bronchi or lungs
·Atypical mycobacteriosis, disseminated
·Recurrent Septicaemia (including non-typhoid Salmonella septicaemia)
·Extra-pulmonary tuberculosis
·Lymphoma (cerebral or B-cell non-Hodgkin)
·Kaposi sarcoma (KS)
·HIV encephalopathy
·Recurrent severe bacterial pneumonia
·Chronic isosporiasis
·Invasive cervical carcinoma
·Atypical disseminated leishmeniasis
·Symptomatic HIV-associated nephropathy
·Symptomatic HIV-associated cadriomyopathy
And/or performance scale 4: bedridden, >50% of the day during the last month

Acknowledgements:

•Dr Natasha Davies
•Dr Jackie Dunlop
•Dr Pappie Majuba
•Wits RHI Safer Conception Project
•Right to Care Training Department