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Early symptomatic HIV infection

Definition

Early symptomatic HIV infection is a stage of infection with the human immunodeficiency virus when symptoms are present but AIDS has not yet developed.

See also:

• Acute HIV infection
• Asymptomatic HIV infection
• HIV infection

Alternative Names

AIDS-related complex - ARC; Chronic symptomatic HIV infection

Causes, incidence, and risk factors

Early symptomatic HIV infection has signs and symptoms typical of HIV infection but not full-blown AIDS. The onset of symptoms signals the transition from asymptomatic HIV infection to HIV disease.

At this early stage of HIV infection, the person does not have signs or symptoms of AIDS such as opportunistic infections, certain cancers, or a CD4 count of less than 200.

Risk factors for HIV infection are:

• Being born to an HIV-positive mother
• Receiving a blood transfusion or blood components
• Injection drug use
• Sexual contact with an infected partner in which there is an exchange of semen or vaginal fluids

Symptoms

• Diarrhea that persists
• Excessive sweating or night sweats
• Fatigue that persists
• Fever that persists
• General feeling of discomfort, illness, or lack of well-being
• Herpes zoster infections (shingles) that keep coming back
• Joint pain
• Mouth disorders
  • Gingivitis
  • Oral hairy leukoplakia of the tongue, caused by a viral infection
  • Oral thrush ("yeast infection")
• Pain, loss of sensation, and inability to control muscles (peripheral neuropathy)
• Skin disorders
  • Fungal infection of the skin or nails
  • Molluscum contagiosum
  • Seborrheic dermatitis
• Swollen lymph glands
• Weight loss

Signs and tests

The patient may have signs of a bleeding disorder in which there aren't enough platelets in the blood (idiopathic thrombocytopenic purpura).

In females, a Pap smear may reveal precancerous cells of the cervix.

The HIV ELISA/Western blot will be positive for HIV antibodies.

The following lab tests may be done to see how the immune system is working:

• CD4 lymphocyte count (type of white blood cell count)
• Complete blood count
• Platelet count
• Skin test anergy

The amount of HIV can be measured in the blood. This test measures the genetic material of the virus called RNA (ribonucleic acid) and is often called the “viral load”.

Treatment

Medications can successfully treat many of the symptoms of early symptomatic HIV infection.

Antiretroviral therapy slows the growth of the HIV virus in the body. A combination of several antiretroviral medications, termed highly active antiretroviral therapy (HAART), work well in reducing the number of HIV particles in the bloodstream, and as a result, increasing the CD4 count.

Although people taking HAART have suppressed levels of HIV, they can still spread the virus to others through sex or sharing needles. HAART is not a cure for HIV, but the treatment slows disease progression and usually strengthens the immune system.

Support Groups

For more information and resources, see AIDS support group.

Expectations (prognosis)

There is no cure for HIV infection or AIDS. However, antiretroviral therapy and HAART can dramatically improve the length and quality of life for people infected with HIV, and can delay the onset of AIDS. The treatments for conditions that occur with early symptomatic HIV disease vary in effectiveness. Some infections and disease processes are easier than others to treat with medications.

Complications

Advanced HIV disease (AIDS) can develop, in which opportunistic infections and cancers (malignancies) can occur.

People infected with HIV can spread the disease to other people. Pregnant women can transmit HIV to their unborn baby.

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of chronic symptomatic HIV infection.

Call for an appointment with your health care provider if you have chronic symptomatic HIV infection and develop new symptoms.

Prevention

You can reduce your risk of getting the infection by practicing safer sex behaviors. However, abstinence is the only sure way to prevent sexual transmission of the virus.

Avoid using intravenous drugs. If you do use intravenous drugs, do not share needles or syringes.

People with AIDS or who have had positive antibody tests can pass the disease on to others and should not donate blood, plasma, body organs, or sperm. They should not exchange genital fluids during sexual activity.

References

Masur H, Healey L, Hadigan C. Treatment of human immunodeficiency virus infection and acquired immunodeficiency syndrome. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 412.

Sax PE, Walker BD. Immunopathogenesis of human immunodeficiency infection. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 408.