Clinical Stages of HIV Infection, their Duration, Symptoms and Signs

Symptoms of HIV (human immunodeficiency virus) positive patients vary according to the stage of the HIV infection. There are three different stages of the HIV disease through which an infected person may go. They include the time period from the date of exposure to the virus till the final progression to AIDS (acquired immune deficiency syndrome).

The stages are progressive in nature if the HIV patient is not taking treatment. All the three stages are infectious and the person at any stage of the disease can pass on the HIV infection to others.

The earlier the HIV infection is diagnosed, the better is the prognosis and the quality of life the person enjoys.

The chances of the infection being missed at the beginning stage are very high because the symptoms of the earlier stages are not typical and mimic other common health conditions.

The second stage is almost without symptoms throwing no suspicions of any kind.

Diagnosis is more likely during the terminal stage of AIDS due to the development of the clinical symptoms of the opportunistic diseases.

AIDS or Acquired Immunodeficiency Syndrome is the last stage and the AIDS symptoms vary according to the opportunistic infection/disease that has set in.

It is the last stage of the ultimate clinical progression of the HIV infection, AIDS, which hits you hard and reduces your chances of survival.

Antiretroviral therapy started at this last stage also may not help much but, it depends on what disease has developed.

Examples of common opportunistic diseases include Pneumocystis carinii pneumonia (PCP), tuberculosis (most common), Kaposi’s sarcoma, and non-Hodgkin’s lymphoma.

Can treatment in early stages cure HIV?

There is no cure for HIV and the virus will stay with till you die. But, the treatment referred to as the antiretroviral therapy can give you a normal span of life if you follow it religiously and regularly.

It controls the virus and contains it, thus helping to increase the CD4 count and improve the body’s immune system.

Early treatment can save millions of life, but what is necessary is to make testing for HIV a routine inclusion and mandatory, worldwide.

This will help in early detection, because according to The Joint United Nations Programme on HIV and AIDS (UNAIDS), 19 million of the 35 million people living with HIV today do not know that they have the virus.

These are the people who mostly develop AIDS and fall victim to it. But, then you can only guess to how many other people they have passed on the viral infection.

The CDC and WHO staging criteria

Now as far as the staging is concerned, we have two authorities who stage the infection using different guidelines.

The Centers for Disease Control and Prevention (CDC) classifies the severity of the disease according the CD4 count. CD4 are cells of the body’s immune system and play a critical role in defending the body against diseases.

These cells are neutralized by the HIV virus and their count goes on falling as the disease progresses.

This classification is rarely used in routine clinical management but is used more in clinical and epidemiological research.

In contrast, the World Health Organization (WHO) classifies HIV disease on the basis of clinical manifestations

The three clinical stages of HIV are:

  • Acute infection stage
  • Clinical latency stage
  • AIDS: Stage when AIDS  sets in

HIV acute infection stage symptoms and signs 

This is the initial stage after getting infected with the Human Immunodeficiency Virus (HIV). It is also called acute HIV, primary HIV or acute retroviral syndrome.

During this stage the virus is multiplying actively inside the body and attacking the immune system. The symptoms of this stage set in about two to four weeks after the person gets infected with the AIDS virus (HIV).

This stage also includes the window period of this infection. The window period is time period between the exposure to the HIV infection and the point in time when the person will test positive for HIV. During this period, the person is infected with the virus and is very infectious, though he/she will test negative. The window period for the HIV is minimum four weeks in most cases. However, it can extend further by another eight weeks.

Not all people develop symptoms during this first stage. About 50% to 90% of HIV positive patients experience these symptoms, which are very much like the flu symptoms but more intense.

These symptoms together are referred to as the acute retroviral syndrome (ARS).  They are common to other illnesses also.

So, one should not associate these symptoms with HIV if you experience them.  Testing for HIV is the only definite way to know if you are HIV positive and the symptoms are due to this virus.

Symptoms of the first stage include:

  • Fever
  • Dry cough that persists in spite of treatment with antibiotics and cough syrups
  • Diarrhea
  • Weakness
  • Sore throat
  • Loss of appetite
  • Loss of weight
  • Swollen lymph glands
  • Skin rash
  • Muscle and joint aches

As the virus is actively multiplying inside the blood stream, there is an inflammatory immune response to this activity. This is what causes the symptoms of fever, swollen glands and weakness. This stage of HIV infection may last for about two months.

Though the HIV positive patient can transmit the infection at all the stages, this initial stage of acute infection is the most infectious. This is attributed to the fast, unchallenged multiplication of the virus during the early weeks of the infection and release of the new virus particles into the blood stream.

During this initial stage, people often develop a very high HIV “viral load” (high amount of virus in the body). But, they usually will not test positive for HIV during this stage, since it takes the body about one to three months to produce antibodies against HIV.

Clinical Latency stage symptoms

Clinical latency stage is the stage when the virus stays latent or dormant. This stage is also referred to as the asymptomatic stage of HIV or the chronic HIV stage.

You will continue to look and feel completely well for long periods of time, usually for many years.

The only reason your doctor may feel suspicious is from your history, which may give him a clue about the presence of the first stage of acute infection.

Signs and symptoms include

There are no symptoms or signs during this stage and the free virus continue to stay in the blood and the cells of the immune system (the white blood cells).

This is the stage when the body and the virus live in harmony with each other. Though there are no symptoms or signs, the infected person will test positive for HIV and can also infect others during this stage.

If the person is on antiretroviral therapy (ART), he or she can continue to live for decades without progressing to AIDS. He or she can still be infectious and can pass on the infection to others via the modes of infection.

Duration

However, for those who do not receive treatment, this stage can last from three years to ten years or maybe more , maybe less – varies from person to person.

Stage of progression to AIDS – AIDS symptoms

As mentioned above, if the infected person is not takinf antiretroviral therapy (ART), he or she develops AIDS (Acquired Immunodeficiency Syndrome) within about ten years of getting infected, after which the average survival time is 2 to 3 years.

ART will slow down this progression to AIDS for decades. As mentioned above during the clinical latency stage, the AIDS virus (HIV) and the immune system of the body are in balance and there are hardly any symptoms.

In the stage of AIDS, the AIDS virus has damaged the immune system making the person very vulnerable to infections.

AIDS is said to have developed when the blood count of the CD4 cells of the immune system falls below 200 per micro liter of blood. The normal CD4 count is 500 to 1200 per micro liter of blood or per mm3

The invading microorganisms take the opportunity of the weakened immune system of the infected person and start invading the body.

These infections are, therefore, called opportunistic infections. These infections would normally never bother a person with a healthy immune system.

There are 26 conditions that can occur in a person who has progressed to AIDS and which can be caused by bacteria, viruses, fungi, and parasites. Almost every organ in the body is affected.

People with AIDS have a high risk of developing viral induced cancers which include Kaposi’s sarcoma, Burkitt’s lymphoma, primary central nervous system lymphoma, and cervical cancer.

There is a very small percentage of people who get infected with HIV but do nor progress to the AIDS. These are called nonprogressors and they seem to have a genetic ability, which prevents the virus from damaging their immune system.

Symptoms of AIDS

  • Recurring fever more than 100 degrees F (38 C) lasting for more than a few weeks
  • Chills
  • Headaches
  • Night sweats
  • Cough with shortness of breath
  • Chronic diarrhea that can last for more than a week
  • Rapid loss of weight
  • Extreme and unexplained fatigue
  • Long standing swelling of lymph glands in the neck, armpits or the groin
  • Sores develop in the mouth, the genital and/or the anus.
  • Lung infection commonly pneumonia
  • Round, brown, reddish or purple spots that develop in the skin or in the mouth caused by Kaposi sarcoma
  • Loss of memory
  • Depressive state of mind

The most common initial conditions that can alert the physician about onset of AIDS are:

  • Tuberculosis (TB). In poor developing nations, TB is the most common opportunistic infection associated with HIV and a leading cause of death among people who have developed AIDS.
  • Pneumocystis  pneumonia, which is seen in 40% of these patients
  • Cachexia or wasting syndrome in which there is muscle atrophy, loss of appetite, loss of weight, fatigue and weakness. These conditions cannot be reversed by extra nutrition. This is seen in about 20% of such patients.
  • Candidiasis infection of the esophagus.

Please note almost all these symptoms of AIDS can be seen with other common illnesses too. The only way to know that AIDS is the cause is to go in for tests to confirm diagnosis of AIDS.

 

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