STAGES OF HIV INFECTION
HIV infection can generally be broken down into four distinct stages.
Stage 1: Acute infection
This is when you first come into contact with HIV. This stage sometimes includes the "window period" which may last approximately six to nine weeks. Most people with HIV may not know that they have become infected. Some have a short illness soon after they become infected; they may have a sore throat, ulcers in the mouth or genitals, fever or a rash, diarrhoea, severe headaches or (rarely) a more severe illness such as meningitis.
During this stage you may go for an HIV test. The result will show that you do not have HIV because the test used is looking for antibodies for HIV and your body has not yet developed them at this stage. It is therefore vitally important to ensure that you go for a follow-up test to determine your final HIV status.
Symptoms during this stage could be caused by other infections such as flu, glandular fever and tonsillitis.
Stage 2: Asymptomatic (without symptoms) HIV infection
During this phase you cannot see that you have HIV and you may feel completely healthy. People who have HIV and feel well may have signs of immune damage detectable only by laboratory tests. Two tests can be done that will indicate how healthy and strong your immune system is - a CD4 count and viral load.
At no time is the HIV inactive. HIV actively replicates itself during the asymptomatic period, primarily in lymph nodes and lymphoid tissue which is a perfect environment for the infection of new CD4 cells.
It is important to remember that although you feel well, you are still able to transmit HIV, so ensure that you protect yourself and others. Planning your lifestyle is important; you may want to start taking vitamins, eat well, stop smoking and reduce your alcohol intake.
The duration of this stage varies widely from person to person. Some decline rapidly (i.e. over a period of two years) but 10% to 15% of people may show no signs of progression for 10 or more years. You may, therefore, have no symptoms, even as your CD4 counts fall to extremely low levels. During the asymptomatic phase, symptoms are usually mild and resolve in time. Sooner or later, clinical signs and symptoms develop and you advance to the next stage.
Stage 3: Symptomatic (with symptoms) HIV infection
The immune system is engaged in constant battle with the rapidly replicating HI virus. For many years, the immune system can hold the HIV in check, but eventually the immune system begins losing the battle. The virus destroys the CD4 cell population. As the CD4 counts continue to drop, signs and symptoms more specific to HIV disease arise.
These include some of the following:
- weight loss
- diarrhoea
- oral thrush and ulcers
- shingles (a painful rash affecting the skin)
- meningitis or peripheral neuropathy (damage to the peripheral nervous system)
- you may have pulmonary TB and should be tested for this.
Stage 4: Acquired Immunodeficiency Syndrome (AIDS)
The progression from HIV to AIDS marks an important milestone in the course of the infection. An irreversible step has been reached. Recovery from individual opportunistic infection (infections that take advantage of weaknesses in the immune system) may well occur and there may be remission for the tumours. However, they do recur, usually with increasing severity and frequency and become more difficult to treat. Receiving an AIDS diagnosis does not necessarily mean that you will die soon; some people have lived for many years after the onset of the disease.
Stage 4 disease usually comprises the identification, diagnosis and treatment of an AIDS-defining illness, which can include:
- tuberculosis (TB) that affects other organs (not only the lungs) i.e. extra-pulmonary TB
- types of cancer such as Karposi Sarcoma, cervical cancer and lymphoma (characterised by enlarged lymph nodes, liver and/or spleen)
- Pneumocystis Carinii Pneumonia (PCP), the most common opportunistic infection that attacks the lungs in persons with HIV
- Meningitis (inflammation of the membranes (called meninges) that surround the brain and spinal cord) and/or encephalitis (inflammation of the brain)
- HIV-associated dementia (a brain disorder in people with severe AIDS, causing loss of thinking capacity and affecting the ability to function).
Approximately 80% of people with AIDS die of secondary infections caused by bacteria or other viruses.
Reference
1. METROPOLITAN FOUNDATION. 2009. B the Future cellbook. South Africa.