What is acute HIV infection?

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The amount of HIV in your blood gets very high within a few days or weeks after HIV infection. Some people get a flu-like illness. This first phase of HIV disease is called "acute HIV infection" or "primary process of HIV infection."

About half of people who become infected do not notice anything. Symptoms usually occur within 2 to 4 weeks. The most common symptoms are fever, fatigue and skin rash. Others include headache, swollen lymph glands, sore throat and all-feeling sensation, nausea, vomiting, diarrhea, and night sweats.

It is easy to ignore the signs of acute infarction from HIV infection. They can be caused by various diseases. If you have any of these symptoms and if there is any chance that you have recently been exposed to HIV, talk to your doctor about getting HIV tests.

Tests for Acute HIV Infection
The normal HIV blood test will return negative for someone who has been very recently infected. The test looks like antibodies produced by the immune system to fight the HIV virus. It may take two months or longer for these antibodies to be produced. See Fact Sheet 102 for more information..

However, the viral load test (See Fact Sheet 125) measures the virus itself. Before the immune system produces antibodies to fight against it, HIV multiplies rapidly. Therefore, this test will show a high acute viral load during HIV infection.

An HIV-negative antibody test and a high viral load indicate recent HIV infection, probably in the last two months. If both tests are positive, then HIV infection probably occurred a few months or more before testing. In June of 2010, the FDA approved a new HIV test that detects both antibodies to HIV and HIV proteins. This new test should detect HIV infection earlier than a test for antibodies alone.

Risk of immune damage
Some people think that there is not much damage done in the early stages of HIV infection. They believe that any damage to their immune system will be cured by taking antiretroviral therapy (ART). This is not true!

Up to 60% of infection fighting "memory" CD4 cells (see Sheet of fact 124) are infected during acute infection and after 14 days of infection, up to half of all memory of CD4 cells can be killed. Also, HIV rapidly reduces the ability of the thymus to replace the loss of CD4 cells. The lining of the small intestine - an important part of the immune system - also loses a significant number of CD4 cells within 4 to 6 weeks after infection. All of this can occur before a person is tested positive for HIV.

Risk of infecting others
The number of HIV particles in the blood is much higher in the acute phase of HIV infection than later. Exposure to someone's blood in the acute phase of infection is more likely to result in exposure infection for someone with long-term infection. A research study estimates that the risk of infection is about twenty times higher in the acute phase of HIV infection.

The risk of transmission of HIV infection through sexual activity is also much higher during the early stage of acute infection.

Treatment of acute ACLs from HIV infection
First, the immune system produces white blood cells that recognize and kill HIV-infected cells. This is called "HIV-specific response." Over time, most people miss this response. Unless they use antiretroviral drugs (ARVs), their HIV disease will move forward.

The United States in guidelines for the use of HIV medications recommends treatment for all people living with HIV. Initiating ARVs during acute attacks of HIV infection may protect the specific immune response.

The researchers studied people who started treatment during the acute infection and then stopped taking ARVs. One study has shown that this treatment can delay time until the immune system is damaged.

Pros and cons of acute treatment of HIV infection
Starting treatment is an important decision. Anyone thinking about making use of ARVs should carefully consider the advantages and disadvantages.

Treatment can change your daily life. Lack of drug doses makes it easier for the virus to develop drug resistance, which limits future treatment options. Fact Sheet 405 you have more information about the importance of taking ARVs correctly.

Medicines are very strong. They have side effects that it can be difficult to live with them for a long period of time and can be very expensive.

Early treatment can protect the immune system against damage caused by HIV. Damage to the immune system shows a lower CD4 cell count and higher viral load. These are associated with higher disease rates. Older people (over forty years old) have weak immune systems. They do not respond to antiretrovirals as well as younger people.

However, not everyone with HIV gets sick immediately. Someone with a CD4 350 cell count and a viral load on 20.000, even though not being treated, has about a 50 / 50 chance of staying healthy for 6 to 9 for years.

Researchers believe that starting treatment at a very early age may allow a patient to stop treatment after a period of HIV control or cure of the infection (as appears to be the case in a young man in the United States).

Bottom line
It is not easy to identify people with acute injury from HIV infection. Some people have no symptoms. If they have symptoms, several other illnesses like the flu may be causing them.

If you think you may be in the acute phase of HIV infection, tell your infectious disease doctor and be tested. Talk to your infectious disease doctor about the possible advantages of ART (Antiretroviral Therapy) and how difficult it can be to start ART during acute attacks of HIV infection.

Medication with ART is an important commitment that, once started, can not be stopped. Discuss the pros and cons of treatment with your medical infectologist and ponder over all the possibilities before you make your decision carefully, always remembering that ART is not a routine that ends in seven days.

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