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Acute HIV infection is the first stage of HIV. Soon after exposure to the virus, a person may experience flu-like symptoms that usually resolve as the body produces antibodies.
During the acute period of infection, the level of virus in a person’s blood is high, as their body is not yet able to mount an immune response. The stage during which the body is producing antibodies is called seroconversion.
Not everyone with an HIV infection develops these symptoms, but they affect at least 50% and possibly up to 80–90% of people with HIV. They appear within 2–4 weeks of exposure and last from a few days to several weeks.
After this, the person will feel better, and they will not experience these symptoms again. However, the virus will stay in the body. Without treatment, it can cause further damage. This stage is called chronic HIV.
Anyone who may have had exposure to the virus and who has acute symptoms should seek medical advice. As other diseases can present similarly, having symptoms does not necessarily mean that HIV is present.
However, if a test is positive, the current treatment for HIV is highly effective, especially if people start treatment early.
People with an acute HIV infection can also have symptoms that include:
- chills and night sweats
- a sore throat
- a rash, which usually consists of small, discolored, flat blemishes that do not itch
- genital sores
- unexplained weight loss
- mouth ulcers
- muscle and joint aches and pains
Many of these symptoms are self-limiting, and people can manage them with medications that relieve pain, swelling, or fever.
It is essential for people to have a test if they have flu-like symptoms and either believe that they may have had exposure to the virus or know themselves to be at risk.
Relieving the acute symptoms will not treat the infection or lower the viral load, and it will not prevent long-term HIV complications.
If a person has an early diagnosis, they can start using antiretroviral treatments to help manage the infection, reduce the amount of virus in their body, and eliminate the risk of the virus transmitting to another person.
The signs of acute HIV infection can resemble those of other illnesses.
However, if a person has symptoms and may have had exposure to the virus — for example, by sharing needles or having sex with a new partner without using a condom or other barrier method — they should consider HIV testing.
Various tests can detect HIV, but not all of them will be accurate at the acute stage, as the body is still producing the antibodies.
HIV antibody tests can detect antibodies in blood and saliva. They may not show that HIV is present in the early stages, as it can take 23–90 days for enough antibodies to develop. Home testing kits are available for purchase online.
Nucleic acid tests (NAT), which use blood from a vein, can show how much virus is present in the blood. They can detect the virus sooner than other tests but are expensive. A person can do this 10–33 days after possible exposure.
An antigen/antibody test can detect p24 antigens, which contribute to the structure of the virus. If the test uses blood from a vein, the results are usually accurate 18–45 days after exposure. This window is 18–90 days for a finger prick test.
The results of tests that use blood from a vein can take several days to return. Finger prick and saliva test results are often ready within about 30 minutes.
As new tests emerge, there is more chance of a quicker, more accurate diagnosis.
HIV transmits when bodily fluids that contain the virus enter another person’s bloodstream — for example, through a cut, sore, or injection site.
These bodily fluids can include:
- preseminal fluid
- vaginal fluids
- rectal fluids
- breast milk
A person is at risk of contracting the virus when they have sex without using protection, such as a condom or PrEP, or share needles with someone who has HIV.
HIV can also pass from a parent to a child during pregnancy, delivery, or breastfeeding, although this is less common.
Less commonly, people who work in a healthcare setting can be at risk of a needlestick injury.
It is not possible for HIV to transmit through shaking hands, the exchange of saliva, or sharing eating utensils, foods, or drinks.
Risk and acute HIV infection
Experts believe that there is a high risk of transmission during the acute stage. The reason for this is that the levels of the virus in the body are high, especially around the middle of this stage.
In addition, the acute stage happens soon after exposure, when a person is likely to be unaware that they may have the infection.
HIV progresses in stages. Without treatment, it will get worse over time. However, treatment can slow or halt its progression.
Stage 1: Acute HIV infection
Acute HIV infection is the first stage of infection, and the symptoms may last for a few days or up to several weeks. They will then disappear, but the virus will stay in the body.
At this point, the person enters stage 2, or chronic HIV infection.
Stage 2: Chronic HIV infection
At this stage, there are often no symptoms, but the virus continues to multiply at low levels. The virus can transmit from the individual to another person.
However, current treatment can reduce the level of the virus so effectively that a test can no longer detect it.
When this happens, the virus is still present in the body, but it cannot:
- cause damage to the immune system
- progress to stage 3, more commonly known as AIDS
- pass to another person
Stage 3: AIDS
Without treatment, chronic infection may progress to the final stage of HIV infection, or AIDS, after 10 or more years.
AIDS develops when HIV has caused so much damage to the immune system that the body is unable to fight the infections that a healthy immune system fights on a regular basis.
Without treatment, AIDS can be fatal within 3 years.
However, thanks to current treatment strategies, most people with HIV will not develop AIDS and can continue to live a full life.
If a test shows that HIV is present, a healthcare team will work with the person to put together a treatment plan.
Treatment can be complex, but it will include antiretroviral drugs, which can reduce the amount of virus in the body.
Antiretroviral therapy can reduce the level of the virus in the blood to the point that it is no longer detectable, cannot cause harm in the body, and cannot pass to someone else.
The following steps can help prevent HIV infection:
- avoiding sharing drug-related equipment, such as needles
- undergoing routine testing, for people who may be at higher risk
- communicating openly with sexual partners about the risk of HIV, any test results, and precautions to take
- using barrier protection, such as a condom, during sex
- limiting the number of sexual partners
- using pre-exposure prophylaxis (PrEP), such as Truvada, if appropriate
- starting post-exposure prophylaxis (PEP) within 72 hours of possible exposure to HIV
- taking precautions to avoid other sexually transmitted infections (STIs), as these can increase the risk of infection with HIV
Individual needs will vary, so people should speak to a healthcare provider about the best way to protect themselves.
In the past, HIV was a life threatening infection. Nowadays, however, there are many ways of preventing infection and managing it if it occurs.
An early diagnosis is one step toward effective treatment that can reduce the amount of virus in the body to undetectable levels.
Anyone who has flu-like and other symptoms that may result from exposure to HIV should seek medical advice.