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Asymptomatic HIV infection

Definition

Asymptomatic HIV infection is a phase of chronic infection with human immunodeficiency virus (HIV) during which there are no symptoms of HIV infection.

Alternative Names

HIV infection - asymptomatic

Causes, incidence, and risk factors

Asymptomatic HIV infection is a period of time, which varies in length from person to person, in which the immune system slowly deteriorates but there are no symptoms.

The length of this phase varies depending on how quickly the HIV virus is copying itself and the individual's genetic differences that affect the way his or her immune system handles the virus.

Some people can go 10 years or longer without symptoms, while others may have symptoms and worsening immune function within a few years after the original infection.

Symptoms

Asymptomatic HIV infection, by definition, does NOT have symptoms typically associated with HIV, such as:

• Fever
• Opportunistic infections (opportunistic means they occur because the weakened immune system provides the "opportunity" for infections to take hold. Serious opportunistic infections include Pneumocystis jirovecii pneumonia, cytomegalovirus, and Mycobacterium avium).
• Oral thrush (also an opportunistic infection, but not life-threatening and does not require a seriously weakened immune system to occur)
• Weight loss

Signs and tests

The diagnosis of HIV infection is based on standard blood tests such as the HIV antibody test (ELISA). A Western blot confirms the diagnosis.

How well an HIV-infected person's immune system is functioning can be determined by measuring the level of certain white blood cells called CD4 lymphocytes (also known as helper T lymphocytes).

Treatment

When a person without symptoms should receive therapy remains controversial. People who are asymptomatic but who have CD4 lymphocyte counts of less than 200 should take treatment to suppress the HIV infection (called antiretroviral therapy). This therapy boosts the immune system and helps prevent opportunistic infections.

Most doctors also recommend antiretroviral therapy for some individuals with CD4 counts between 200 and 350, and perhaps for those with even higher CD4 counts (depending on the level of HIV in the person's blood). However, factors other than blood test results must be considered, such as patient readiness and ability to stick to the therapy regime, before prescribing antiretroviral therapy.

Support Groups

See: AIDS - support group

Expectations (prognosis)

There is currently no cure for HIV infection or AIDS. However, antiretroviral therapy and HAART can dramatically improve the length and quality of life of people infected with HIV, and can delay the onset of AIDS.

Complications

People with asymptomatic infection can progress to symptomatic HIV infection, develop opportunistic infections associated with HIV, and transmit HIV to other people. In addition, pregnant women with asymptomatic HIV infection can still transmit HIV to their fetus.

Calling your health care provider

Call your health care provider if you have HIV and you develop fevers, weight loss, swollen glands, night sweats, or any other persistent symptoms. You will need to be checked, and your doctor might consider giving you antiretroviral therapy.

Prevention

You can lower the risk of sexually transmitting the HIV infection by practicing safer sex behaviors, as well as avoiding contact with contaminated blood (not using injection drugs or not sharing needles or syringes).

Abstinence is the only absolutely sure way to prevent sexual transmission of the virus.

People who have had positive HIV antibody tests should not donate blood, plasma, body organs, or sperm. They should not exchange genital fluids during sexual activity.

People at risk for HIV infection should have regular testing to ensure early diagnosis of this infection, as many treatment options are available.

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.