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Am Fam Physician. 1999;60(2):545-546

See related article on acute HIV syndrome.

What is acute HIV syndrome?

HIV syndrome is a name for the early stage of HIV infection, when you first get infected with the HIV virus. HIV stands for human immunodeficiency virus. These are some of the symptoms of acute HIV syndrome:

  • A fever

  • A tired feeling

  • Swollen lymph nodes

  • Swollen tonsils (also called tonsillitis)

  • A sore throat

  • Joint and muscle aches

  • Diarrhea

  • A rash.

The symptoms of acute HIV syndrome usually last for about 14 days after HIV exposure. They could last for just a few days, or they could last for several months.

You might not realize your illness is acute HIV infection. For one thing, the person you caught HIV from may not even look sick. And the signs and symptoms of HIV infection may look just like mononucleosis (mono), tonsillitis or the flu.

What tests can show that I have acute HIV infection?

When HIV enters your body, it moves inside white blood cells called “CD4 lymphocytes.” HIV takes over the CD4 cells and makes billions of virus pieces each day. The virus pieces spread through your body.

Your body tries to defend itself against HIV by making the following:

  1. Antibodies (these hook on to the virus and keep it from making virus pieces).

  2. Special cells called macrophages and natural killer T-cells. These cells help you to get rid of some of the virus pieces. If antibodies against HIV show up in your blood, you know your body is trying to protect you from the HIV infection you have picked up. However, it's usually several months before your body makes enough antibodies to measure.

So at the time you have acute HIV syndrome, you probably won't have enough HIV antibodies in your blood to measure, and this test can't give you a diagnosis.

However, when you have acute HIV syndrome, you do have a high level of HIV RNA in your blood. A test can measure the amount of HIV RNA in your blood. (RNA is the short name for “ribonucleic acid”. RNA is made when the virus is active.) This test tells your doctor that you're feeling sick because you have acute HIV syndrome.

What happens after a person gets HIV infection?

After acute HIV infection, your body works hard to attack the virus. With your body fighting, the virus can't make so many virus pieces. Even though you still have HIV infection, you'll begin to look well and feel well again. The usual blood tests will be normal.

However, during this time, the virus pieces are still attacking your lymph nodes. Lymph nodes are the centers of your body's immune system. The virus may also attack your brain tissue and slowly cause damage there.

Over 10 to 15 years, HIV would kill so many CD4 cells that your body could no longer fight off infections. At this point, we would say that you have AIDS (acquired immunodeficiency syndrome). Once you have AIDS, you can easily get many serious infections.

Does it help me to find out I have HIV at an early stage?

Yes. Right now, we have no cure for HIV infection. Your body can make antibodies and killer T-cells to slow down the progress of HIV, but they can't get rid of the virus. In fact, the very act of going after HIV may wear out your immune system in a short time.

However, we know that treatment with HIV medicines (usually at least three at once) can hold down the virus and keep your body's immune system strong for a longer time. That's why the Centers for Disease Control and Prevention (CDC) recommends early treatment of people with acute HIV syndrome.

How is HIV treated?

HIV treatment must last for a long time (maybe forever). A kind of medicine called reverse transcriptase inhibitors stops the virus from taking over the CD4 lymphocytes—but this medicine can't work if the CD4 takeover has already happened. To get help from these medicines, you have to start taking them at an early stage. You might take two of these medicines at one time.

Another kind of medicine, called protease inhibitors, works later in the life cycle of HIV. It stops the infected CD4 cells from making more virus pieces.

If you have HIV, you'll have to take many pills and liquids several times a day. Side effects are common. You might have nausea, bloating, diarrhea and headaches. You might notice mood changes or have serious reactions to the medicines. Some of these medicines can cause kidney stones or keep your kidneys from working right.

Because you have to keep taking these medicines for such a long time, it's important to find a medicine plan you (and your body) can get along with.

Remember that it's not good to just stop taking any of your medicines, or to take fewer pills every day. It's important to take some of your medicines with food and to take some medicines between meals. If you don't follow the doctor's directions, you might develop a virus that is resistant to the medicines.

What's in the future?

Combination drug therapy has changed HIV disease from the leading killer of young adults to a chronic illness that we can control for decades. However, even though you can take HIV medicines and feel OK, you could still give the virus to others through unsafe sex or blood exchanges. The medicines don't kill the virus—they just keep your immune system strong enough to stop AIDS or slow it down.

At this time, we're trying to make new medicines that you can take less often and that are more powerful in holding back the virus.

Where can I get more information about HIV?

For more information, you can call the national AIDS hotline: 1-800-342-AIDS.

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