Primary HIV infection
50-70 % of the HIV infected develop symptoms 2-4 weeks after infection. This is known as acute or primary HIV infection. The usual symptoms are
- sore throat
- swollen lymph nodes
- muscle and joint pain
The symptoms may resemble influenza and mononucleosis (“glandular fever”) and usually last 2-3 weeks. After this phase, the symptoms disappear and the person feels healthy.
It is important to detect a primary HIV infection, because:
- with primary HIV infection and the first months after infection, there is a high concentration of virus in the blood and therefore a high risk of infection.
- with primary HIV infection, it is a short time since infection. This makes contact tracing easier and reduces the risk of further spread.
- a specialist in infectious diseases should consider antiviral treatment in each case.
Even without treatment, 50 % of people with HIV infection will show no signs of disease after 10 years. People with HIV infection are at greater risk of tuberculosis infection progressing to disease
The amount of virus (viral load) in the blood after infection will gradually subside within 4-6 months and then stabilise at a certain level that varies from person to person. The disease progresses faster in people with a high stable viral load than with a lower viral load. The speed of disease progression varies from person to person. Statistics show that even without treatment, 50 % of people with HIV infection will have no symptoms of disease after 10 years.
Current treatment can effectively delay the deterioration of the immune system and the resulting complications. Therefore, these complications arise far less frequently now than in the days before effective treatment was available.
Early symptomatic HIV infection
In people with weakened immune systems, common diseases will occur more frequently and have a longer and more complicated course than in people with a normal immune system. When the number of CD4 cells decreases, other conditions could arise, such as fungal infections (thrush) in the mouth or the vagina. Other fungal infections such as athlete’s foot and nail fungus can be troublesome.
Herpes can cause serious problems, as can common warts and genital warts. Another early symptom of a weakened immune system can be shingles (herpes zoster). This is caused by a reactivation from childhood of the chickenpox virus. Skin problems are common, especially eczema with redness and flaking of the face and upper chest and back. Other skin diseases may also appear.
People with HIV infection have a greater risk that a tuberculosis infection will progress to disease, and reactivation of tuberculosis can be seen quite early in the course of an HIV infection. In Norway, few people have both HIV infection and tuberculosis but this combination is far more common globally. Tuberculosis should be considered for anyone with HIV infection, especially for those coming from countries with a high prevalence of tuberculosis.
Advanced HIV infection
Advanced HIV infection is seen less frequently today since most HIV infections are detected relatively early and treatment can begin before they develop. With CD4 counts of around 200, serious opportunistic infections may arise. These are infections by microbes that a healthy immune system would manage to control. Pneumonia caused by the fungus Pneumocystis jiroveci is serious if the diagnosis is delayed or proper treatment is not given.
Today, this form of pneumonia is mainly seen in people who are not being treated for HIV because they are not aware that they are infected.
Approximately 15 % of the population are carriers of the toxoplasmosis parasite, which can cause brain infection among people with weakened immune systems. Those who are not carriers and have a weakened immune system are advised to avoid contact with cats and to avoid meat that is not thoroughly cooked. Some viruses that we carry can be reactivated and cause disease.
Cytomegalovirus (CMV) is a virus that infects many, and approximately 60% of the adult population are carriers. With a weakened immune system, this virus may be reactivated and cause severe infection in a variety of body organs. The eyes are often affected. At the advanced stage of HIV infection, increased rates of cancer are also seen, including Kaposi’s sarcoma and lymphoma (cancer of the lymph nodes).
Other HIV-related diseases
Studies in recent years have shown that HIV positive people have an increased incidence of a variety of diseases that usually affect older, uninfected people. These include cardiovascular diseases, osteoporosis, liver diseases, kidney diseases, cancer and diabetes. This may be because HIV causes inflammation, particularly in the arterial walls, and an increased tendency to blood clots.
HIV positive people with other risk factors for disease (e.g., cardiovascular disease), together with side effects from HIV treatment may also affect the development of such diseases at an early age. As more HIV positive people age, it is important to check for other health problems than the traditional HIV-related diseases.