What are symptoms and signs of HIV infection and AIDS?
The time from HIV infection to the development of full blown AIDS varies. Sometimes, individuals develop complications of HIV that define AIDS within one year, while others remain completely asymptomatic after as many as 20 years from the time of infection. However, in the absence of antiretroviral therapy the time for progression from initial infection to AIDS is approximately 8 to 10 years. The reason why people experience clinical progression of HIV at different rates remains an area of active research.
Within weeks of infection, many people will develop the varied symptoms of primary or acute infection which typically have been described as “influenza” like illness but can range from minimal fever, body aches, and pains to very severe symptoms. The most common initial symptoms of primary HIV infection are fever, aching muscles and joints ,sore throat, and swollen glands (lymph nodes) in the neck.
It is not known why only some HIV-infected people develop these symptoms. It also is unknown whether or not having the symptoms is related to the future course of AIDS disease. Nevertheless, infected people will become symptom-free after this phase of primary infection. During the first weeks of infection when a patient may have symptoms of primary HIV infection, antibody testing may still be negative, this is called window period. If there is suspicion of early infection based upon the types of symptoms present and a potential recent exposure, then a test is performed that specifically looks for the virus circulating in the blood, which is called a viral load test or the use of an assay that identifies HIV p24 antigen, for example, the new fourth-generation antibody/antigen combination test. Identifying and diagnosing individuals with primary infection at an early stage is important to assure early access into care and to counsel them regarding the risk of transmitting to others. The latter is particularly important since patients with primary HIV infection have very high levels of virus throughout their body and are likely to be highly infectious. Once the patient enters the asymptomatic phase, infected individuals will know whether or not they are infected if a test for HIV antibodies is done.
Shortly after primary infection, most individuals enter a period of many years where they have no symptoms at all. During this time, CD4 cells may gradually decline, and with this decline in the immune system, patients may develop the mild symptoms of HIV such as vaginal or oral candidiasis thrush (a fungal infection), fungal infections of the nails, a white brush-like border on the sides of tongue called hairy leukoplakia, chronic rashes, diarrhea, fatigue, and weight loss. With a further decline in function of the immune system, patients are at increasing risk of developing more severe complications of HIV, including many more serious infections (opportunistic infections), malignancies, severe weight loss, and decline in mental function. From a practical perspective, most physicians think about patients with HIV diseases as having no symptoms, mild symptoms, or being severely symptomatic. In addition, many would characterize a patient’s level of immunosuppression by the degree and type of symptoms they have as well as the CD4 cell count. The Centers for Disease Control and Prevention have defined the presence of a long list of specific diseases or the presence of less than 200 CD4 cells per mm3 as meeting a somewhat arbitrary definition of AIDS. With effective antiretroviral therapy many of the signs and symptoms of HIV as well as immunosuppression can be completely reversed, restoring even the most symptomatic patients to a state of excellent health.