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When people get HIV and don't receive treatment they will typically progress through three stages of the disease process. Stage one: acute HIV infection. This happens within two to four weeks after infection with HIV. The patient may experience a flu-like illness, which may last for a few weeks, and this is body's natural response to the infection. When people have acute HIV infection they have a large amount of virus in their blood and are very contagious. People with acute infection are often unaware that they are infected because they may not feel sick right away or even at all. To know whether someone has acute infection either a fourth generation antibody/antigen test or a nucleic acid test is necessary. If you think you have been exposed to HIV through sex or drug use and you have flu-like symptoms, seek medical care and ask for a test to diagnose acute infection. Stage two: the clinical latency, or HIV inactivity or dormancy period. This period is sometimes called asymptomatic HIV infection or chronic HIV infection. During this phase HIV is still active, but reproduces at very low levels. People may not have any symptoms, or even get sick during this time. For people who aren't taking medicine to treat HIV, this period can last a about a decade or longer, but some may progress through this phase faster. People who are taking medicine to treat HIV the right way, every day may be in this stage for several decades. Remember that people can still transmit HIV to others during this phase, although people who are on ART and stay virally suppressed, which means having a very low level of virus in their blood, are much less likely to transmit HIV than those who are not virally suppressed. At the end of this phase a person's viral load starts to go up and the CD4 cell count begins to go down. As this happens the person may begin to have symptoms as the virus levels increase in the body, and the person moves into stage three. Stage three: the Acquired Immunodeficiency Syndrome. AIDS is the most severe phase of HIV infection. People with AIDS have such badly damaged immune systems that they get an increasing number of severe illnesses called opportunistic illnesses. Without treatment, people with AIDS typically survive about three years. People are diagnosed with AIDS when their CD4 cell count drops below 200 cells per millimeter, or if they develop certain opportunistic illnesses. People with AIDS can have a high viral load and be very infectious. Common symptoms of AIDS include chills, fever, sweats, swollen lymph glands, weakness, and weight loss. Testing and diagnosis of HIV and AIDS. The only way to know for sure whether you have HIV is to get tested. The CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of a routine health care. Knowing your HIV status gives you powerful information to help you take steps to keep you and your partner healthy. If you test positive, you can take medicine to treat HIV to stay healthy for many years, and greatly reduce the chance of transmitting HIV to your sex partner. If you test negative, you have more prevention tools available today to prevent HIV than ever before. If you are pregnant, you should be tested for HIV so that you can begin treatment if you're HIV-positive. If an HIV-positive woman is treated for HIV early in her pregnancy, the risk of transmitting HIV to her baby can be very low. There are three types of tests available. The first test is the Nucleic Acid Test, or NAT. This is a very accurate test that looks for the actual virus in the blood. Usually it's considered accurate during the early stages of infection, but it's very expensive and not routinely used for screening individuals unless they recently had a high risk exposure or a possible exposure and they have early symptoms of HIV infection. The second is an antigen/antibody test. This looks for both HIV antibodies and antigens. It's also a rapid antigen/antibody test, which is now available. And then thirdly is just the antibody test. HIV tests are typically performed on blood or oral fluid, and they may also be performed on urine.
In this lesson, we're going to take a look at the three stages of HIV infection, as well as explore some common symptoms, and finally, we'll look at the three types of tests that are available to diagnose the infection.
When people contract the HIV virus and do not opt for any type of treatment, they will usually progress through all three stages of the disease process – from acute HIV infection to the clinical latency period and ultimately the last phase – AIDS.
Stage 1 – Acute HIV Infection
Acute HIV infection typically occurs within two to four weeks after the person has been infected with the HIV virus. It usually is accompanied with flu-like symptoms which can last a few weeks, as this is the body's natural response to the infection.
People in Stage 1 have large amounts of the HIV virus in their blood and are extremely contagious. To compound problems, people in Stage 1 are often unaware that they even have the infection and may not feel sick immediately or at all.
To confirm HIV infection, testing is necessary. And we'll get into more details about these tests later in the lesson.
Pro Tip #1: People who suspect that they may have the HIV infection, especially if there's a chance they obtained it through drugs or sex and also have flu-like symptoms, should get tested as soon as possible.
Stage 2 – Clinical Latency (HIV Inactivity or Dormancy)
Stage 2 is sometimes referred to as the asymptomatic HIV infection period or chronic HIV infection. During this stage of the disease, the HIV virus is still active, but it reproduces at very low levels.
A person in Stage 2 may not have any symptoms at all or feel sick in any way. If not treated, this period can last 10 plus years, though some people may progress through this stage faster than others.
For those taking medications to treat their HIV, like with antiretroviral therapy (ART), Stage 2 can last several decades.
Pro Tip #2: It's important to note that people in Stage 2 can transmit the HIV infection to others. However, if taking medications like ART that suppress the infection, they will likely have very low levels of the virus in their blood, which means they are less likely to transmit the virus than someone not receiving treatment.
At the end of Stage 2, the viral load begins to increase and the CD4 cell count begins to decrease. As this happens, the HIV infected person may begin having symptoms that often accompany Stage 3.
Stage 3 – Acquired Immunodeficiency Syndrome (AIDS)
Stage 3 is obviously the most severe phase of HIV infection. People who have AIDS will have badly damaged immune systems and are more likely to get an increasing number of severe illnesses as a result.
These types of illnesses are sometimes referred to as opportunistic illnesses. Without any type of treatment, people in Stage 3 typically survive about three years.
A diagnosis of AIDS is confirmed when the CD4 cell count drops below 200 cells/mm or if the person develops one of those opportunistic illnesses mentioned above. People with AIDS will have a high viral load and will be very infectious.
Common symptoms of Stage 3/AIDS include:
- Chills
- Fever
- Sweating
- Swollen lymph glands
- Weakness
- Weight loss
HIV/AIDS Testing and Diagnosis
The only way to know for sure if someone has the HIV infection or AIDS is to get tested. The Centers for Disease Control and Prevention (CDC) recommends that everyone between the ages of 13 and 64 get tested for HIV as part of their routine healthcare checkups.
Knowing your HIV status provides you with important information that will help you take the necessary steps to keep you and your partner healthy moving forward.
If an individual tests positive for HIV infection, medications and treatment can result in remaining healthy for many more years and greatly reduce the chance of transmitting the disease to their sex partner. And if an individual tests negative, there are more prevention tools available today that can help prevent HIV infection than ever before and keep that person from contracting the disease.
HIV and Pregnancy
Pregnant women should be tested for HIV and should begin treatment immediately if tests come back positive. If an HIV-positive woman receives treatment for HIV infection early during her pregnancy, the risk of transmitting HIV to her baby can be very low.
The 3 Types of HIV/AIDS Tests Available
1. Nucleic Acid Test (NAT)
This test looks for the actual HIV virus in the blood and is usually considered very accurate during the early stages of HIV infection. However, this test is quite expensive and not routinely used unless the individual recently had high risk or possible exposure and they're also exhibiting early symptoms of HIV infection.
2. Antigen/Antibody Test
This test looks for HIV antibodies and antigens in the blood. An antigen is a part of a virus that triggers an immune response. If you've been exposed to HIV, antigens will show up in your blood before HIV antibodies are made. This test can usually find HIV within two to six weeks of infection.
3. Antibody Test
Antibodies are produced by the body in reaction to the presence of a virus. An HIV antibody test measures the presence of antibodies in response to the presence of HIV. The most common HIV antibody tests are ELISA (EIA) and Western Blot. These tests can now be performed on samples of oral (mouth) fluid.