HIV timeline: What are the stages?
The virus is transmitted through certain bodily fluids, and the condition is life-long. Activity progresses over time, but current treatment can help to slow or stop the progression.
In some parts of the world, including the United States, appropriate treatment and regular monitoring now mean that the viral load, or level of virus in the blood, can become undetectable.
As long as the person follows their treatment plan and has regular blood tests to ensure the virus levels remain undetectable, the body will stay healthy, and the virus will not be transmitted through sexual activity.
Without treatment, HIV continues to damage the immune system cells. The body will be more susceptible to certain conditions known as opportunistic infections and diseases. Acquired immune deficiency syndrome, or AIDS, is a syndrome that can result when the body is no longer able to withstand such conditions.
Current treatment — and especially early treatment — can prevent AIDS from developing.
The Centers for Disease Control and Prevention (CDC) describe opportunistic infections as "infections that occur more frequently and more severely in those with weakened immune systems, including people with HIV."
There are three stages to HIV infection.
Stage 1: Acute HIV infection
The acute stage of HIV infection may involve flu-like symptoms within the first month of contracting the virus.
At stage 1, the bloodstream contains high levels of the virus. At this time, it can easily be passed to other people.
Within 2 to 4 weeks of exposure, many people develop flu-like symptoms. Not everyone has these symptoms, however, and it is possible for HIV to progress without any indication that the virus is present in the body.
These flu-like symptoms represent the body's natural response to an infection as it attempts to kill off the virus. However, the human body cannot completely remove this virus once it is present.
The virus replicates itself using the body's own CD4 cells and spreads throughout the body. In the process, it destroys the CD4 cells.
Eventually, this process stabilizes. The immune system reduces the level of viral cells, while the CD4 cell count increases. However, CD4 cells may not return to their original level.
Symptoms at the acute stage
At stage 1, symptoms may include:
- muscle and joint aches and pains
- raised temperature
- ulcers in the mouth
- night sweats
- body rash
- sore throat
- swollen glands
It is important to seek medical help if these symptoms occur, especially if the individual believes they may have been exposed to the HIV virus. Early treatment can be effective in reducing the impact of HIV.
Pre-exposure prophylaxis (PrEP) can be taken on a regular basis to prevent HIV from taking hold, even if exposure occurs.
Stage 2: Clinical latency
During the second stage, the virus is active but reproduces at very low levels. At this stage, there are usually no symptoms, or very mild ones. This is why stage 2 is also known as the "asymptomatic stage."
Those who follow a treatment program may remain in this stage for many decades, possibly for the rest of their life, as drug therapy reduces viral activity. Without treatment, the clinical latency stage lasts around 10 years.
Treatment can reduce the levels of the virus to such an extent that it is undetectable. This means that the body remains healthy, and the virus is untransmittable.
However, if viral levels are detectable, the virus can be passed on to another person at this stage, even if there are no symptoms. It is important to have regular monitoring to ensure the undetectable level is maintained.
Those living with HIV are encouraged to follow their treatment plan with care and attend all appointments.
Everyone — whether they have this virus or not — should take appropriate precautions to avoid or prevent transmission of HIV and other diseases.
Stage 3: AIDS
Stage 3 HIV is also known as AIDS, but AIDS is a different and separate diagnosis from HIV. HIV is a virus, but AIDS is a syndrome, with a range of features and symptoms.
In people who are undergoing drug therapy for HIV, their level of immunity remains strong enough to prevent the condition from progressing to AIDS. With current treatment options, AIDS is unlikely to develop.
Without treatment, however, the viral load can increase, and the CD4 cell count can drop. This reduced immunity leaves the body susceptible to various infections and diseases, which can be life-threatening.
An AIDS diagnosis is made when the CD4 cell count of someone with HIV drops to under 200. A healthy CD4 count is between 500 and 1,500 cells per millimeter cubed (cells/mm3).
Alternatively, the development of one or more opportunistic infections can also indicate the virus has progressed to AIDS.
Symptoms at stage 3
Symptoms at this stage vary greatly, as they tend to be associated with various opportunistic infections.
Some of the more common symptoms include:
- blotches under the skin or in the mouth and nose
- blurred vision
- diarrhea lasting longer than 1 week
- swollen lymph glands
- constant tiredness
- fever that keeps coming back
- memory loss
- weight loss
- mouth, anus, or genital sores
A post-exposure prophylaxis or PEP drug may be taken within 72 hours of exposure to HIV and has a high success rate in reducing new infections.
The most effective way of slowing or stopping the progression of HIV is through early diagnosis and appropriate drug therapy.
Early treatment is essential.
The sooner diagnosis occurs, the sooner a drug treatment program can start, and the greater the chance of enjoying a normal or near-normal lifespan.
Early diagnosis also lowers the risk of transmitting the virus to others.
Two types of medication are used to inhibit the progression of the virus.
Antiretroviral therapy (ART)
The medication used to treat HIV is known as antiretroviral therapy (ART). This treatment is beneficial at all stages of the virus.
- suppresses viral activity
- increases the individual's immunity and chance of a longer lifespan
- reduces the chances of passing on the virus
Doctors can adapt the combination of drugs used to each patient. The prescribed schedule of medication should be strictly followed in order to ensure its effectiveness and prevent the virus becoming resistant to the drugs.
Pre-exposure prophylaxis (PrEP)
Preventive medication is available for those who do not have the virus but have a higher risk of contracting it. One pill is taken each day. Taken consistently, it can reduce the risk of getting the virus by up to 92 percent.
Post-exposure prophylaxis (PEP)
This is an emergency treatment that can be given to someone who believes they have been exposed to HIV within the previous 72 hours. It aims to stop HIV from becoming a lifelong condition.
The World Health Organization estimate that when taken correctly, the 28-day course of PEP reduces the risk of HIV infection by over 80 percent.
Once a person has a diagnosis of HIV, certain lifestyle factors play a role in its progression, particularly those that boost the immune system and help the body fight infection.
- Reducing stress: Stress weakens the immune system and increases the risk of developing other illnesses and opportunistic infections.
- Avoiding infections: People with HIV should take steps to protect against infection and illness, and get regular vaccinations if advised to by a doctor.
- Using condoms during intercourse: Condoms reduce the risk of transmitting HIV to others. They also safeguard those with HIV against other sexually transmitted infections that will further weaken immunity.
- Quitting smoking: Smokers with HIV are more likely to get infections such as candidiasis and pneumonia, or other illnesses, such as certain cancers, heart disease, and chronic obstructive pulmonary disease (COPD).
- Exercising regularly: A regular exercise plan brings many benefits to those living with HIV, including a lower risk of heart disease, increased energy, improved circulation and lung capacity, better sleep, and less stress.
- Eating a healthful diet: Maintaining a balanced diet with a low alcohol intake will help to boost the immune system and ward off infections. Nutritious food can help the treatment to work properly.
Other factors affecting progression
Quitting smoking is recommended for people with HIV.
Some of the factors that affect disease progression can be controlled by people with HIV, but others can also have an impact.
Factors that people cannot change include:
- general health before infection
- HIV subtype
- the presence of other infections
The outlook depends largely on whether or not a person receives and follows a treatment plan.
If treatment begins before the virus advances, and the individual follows the regimen as recommended, people with HIV can now expect to live as long or almost as long as those who do not have the virus.
Appropriate treatment can lead to a state known as "viral suppression." This means that the body is healthy and the virus cannot be transmitted.
According to the CDC, "When ART results in viral suppression, defined as less than 200 copies/ml or undetectable levels, it prevents sexual HIV transmission."
People who have the HIV virus and do not seek treatment will generally develop stage 3, AIDS, within 2 to 15 years after infection.
After a diagnosis of AIDS, people who do not have treatment typically survive for 3 years. If a person who is not receiving treatment for AIDS also develops an opportunistic illness, their life expectancy drops to 12 months.