People often overlook the first signs of HIV which is why many people live with the infection for years before even knowing they’re HIV positive. So first of all, commend yourself for getting tested. By doing so you have taken the first proactive steps towards protecting your health. Catching an HIV infection early allows you to get treatment as soon as possible. You are not alone: millions of people are living normal lives with HIV by taking the proper precautions. Your diagnoses does not define your character or your future. Regardless, receiving a HIV diagnosis can leave you scared, angry, and confused – especially if you feel fine! Our goal here is to offer you some clarity surrounding what your body is going through in the first months of infection.
Acute HIV is a clinical syndrome that occurs in 40-90% of people shortly after becoming infected, corresponding to the 2-4 week period when viral replication is at its peak. The first signs of HIV are symptoms that we easily mistake for the flu or mono. These include things like fever, achiness, sore throat, or rash. It is particularly easy to pass the virus to partners during this period. In fact, it’s estimated that people in this early stage are responsible for 50% of new HIV infections.
For some people it manifests as a significant illness, but for most it is so mild that it’s often completely overlooked. In addition to minimal symptoms, people usually have an undetectable viral load in the first two weeks. Luckily the current most sensitive HIV test, called the “4th Generation” test, can detect HIV two to four weeks after infection. This allows clinicians to catch the virus in these critical, most contagious weeks. Previous tests could only detect infection six weeks to three months after acquisition.
The viral symptoms resolve spontaneously and if a clinician doesn’t consider or test for Acute HIV, they often miss the diagnosis. Once these first signs of HIV pass, the infection often remains asymptomatic for many years. After the first 4 weeks but within the first six months of contracting the virus, it is referred to as Early HIV Infection. Viral levels continue to remain high during the first four months and then gradually decline to a lower level. Levels can remain low for many years before signs of illness develop. Because of the silent nature of the infection, people can be harboring it for ten or more years without knowing. It’s important to note that even if you aren’t currently experiencing symptoms, it is still possible to spread the virus to partners.
Regular testing is critical because early detection leads to earlier treatment. The earlier anti-retroviral treatment (ART) begins, the earlier you can become non-contagious. Clinicians call this concept TasP, or treatment as prevention. Another key reason for early treatment is that it provides a greater chance for normal levels of CD4 lymphocytes. These lymphocytes are specific white blood cells which keep the immune system strong. The HIV virus hijacks the cellular machinery of the CD4 cells and uses it to self-multiply, quickly spreading throughout the body.
When left untreated, HIV will continue to attack and destroy these CD4 cells. Without these cells, the body is more vulnerable to infection. ART stops HIV from replicating. That said, you must take medication daily to keep viral reservoirs (dormant HIV throughout the body) from reactivating. While not a cure, consistent ART treatment can drop a person’s viral load (amount of virus in the blood) to a level so low that it is undetectable. This also means that person wouldn’t transmit the virus sexually. At that point, they are considered ‘functionally cured’.
So regardless of whether or not you’re experiencing symptoms, if you’ve tested positive for HIV it’s important that you take proper precautions going forward. By screening yourself for STI’s and catching your infection early you give yourself the greatest chance of a long and healthy life.
To learn more about HIV and staying healthy, you can read “What’s PrEP and Who’s it For.”
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 Robb ML, Eller LA, Kibuuka H, et al. Prospective study of acute HIV-1 infection in adults in east Africa and Thailand. N Engl J Med. 2016;374(22):2120-2130. Available at: https://www.ncbi.nlm.nih.gov/pubmed/27192360.