Acute stage of HIV. HIV and AIDS - life and diagnosis

I am periodically asked what my symptoms of HIV were after infection. As I often do with repetitive questions, I'll answer with a post and link to it later. Although I have a vague feeling that I have already written about this, I could not find it in my own LiveJournal either by tags or by a full-fledged search.

So, I had a perfectly classic acute stage, like a textbook. A few weeks after infection, an ARVI-like condition occurred: great weakness, fever, fever. At the same time, there were no signs of ARVI in the form of a runny nose or cough. During the day, the temperature increased to 38 and above, appeared strong pain in the throat, increased fever and general weakness. All this went on for several days, I don’t remember exactly how long. After about 3-4 days, I went to the doctor, because. The temperature did not subside and the condition did not improve. I was given some standard diagnosis such as angina, prescribed antibiotics. A few days later the temperature began to subside, but there was a very strong physical weakness, I lay almost all day without getting up. About a week after the onset, the fever began skin reaction in the form of spreading red spots, the spots were mainly on the hands and face, and looked like sunburn. The doctor said it was most likely allergic reaction for antibiotics. Simultaneously with all this, lymphadenopathy began (I don’t remember exactly at what moment), I clearly remember how I clearly felt submandibular lymph nodes. They did not hurt, but I felt them by some kind of pulling sensation. The temperature at the same time subsided, but continued to stay at the subfebrile level. This condition, together with severe physical weakness, continued for another couple of weeks, then gradually everything returned to normal. The lymphadenopathy lasted the longest, probably for several months, then it also disappeared.

As is already clear from the above, neither I nor the doctors I consulted at that time had any suspicions about HIV. I remembered this “angina” of mine after I received an HIV diagnosis 2 years after the described symptoms. And these symptoms, which clearly fell under the non-specific symptoms of OS, along with a clear risk of infection at that time, allowed me to know exactly the moment of infection.

I will add that the person from whom I received HIV was at that time in an acute stage, because. a couple of weeks before our sexual relationship, he had a negative HIV test, but no obvious symptoms It didn't have an OS. This confirms the fact that a large number of infections occur precisely during the acute stage, when VL is very high, and the person is not yet aware of his diagnosis.

And finally, my case confirms the relationship between the bright manifestation of the acute stage and the rapid progression of HIV infection. At the time of diagnosis, 2 years after infection, my SI was already around 300, and after 4.5 years it dropped to 190 and I started therapy.

• RISK OF INFECTION TO OTHERS
• TREATMENT OF ACUTE HIV INFECTION
• TOTAL

WHAT IS THE ACUTE STAGE OF HIV INFECTION?
Within a few days or weeks after contracting HIV infection, the amount of virus in the blood becomes very high. Some people develop an illness with flu-like symptoms. This first stage of HIV infection is called "acute HIV infection" or "primary HIV infection".

About half of the people who become infected with HIV do not notice anything. Symptoms usually appear within 2 to 4 weeks. Most common symptoms are heat, fatigue, and rash. Other symptoms include headache, swollen lymph glands, sore throat, feeling weak, nausea, vomiting, diarrhea, and night sweats.

Signs of acute HIV infection are very easy to miss. Similar symptoms can be caused various diseases. If you have any of these symptoms, and if there is a chance that you have recently been exposed to HIV infection, talk to your doctor about getting tested for HIV.

TESTING FOR ACUTE HIV INFECTION
A routine HIV blood test will show a negative result for those who were most recently infected. The test checks the blood for antibodies produced immune system in the fight against HIV. It may take the body two months or more to produce these antibodies. See Fact Sheet 102 for more details.

However, there is a viral load test (see leaflet 125) that measures the amount of the virus itself. Before the immune system can produce antibodies to fight the virus, HIV multiplies rapidly. Thus, in acute HIV infection, the test will show a high viral load.

A negative HIV antibody test and a very high viral load indicate recent HIV infection, most likely within the past two months. If both tests are positive, then HIV infection probably occurred several months or more before the test. A special "detuned" version of the HIV antibody test is less sensitive. It detects only those infections that have occurred at least four to six months before the test. This test can be used to detect cases of acute HIV infection.

RISK OF DAMAGE TO THE IMMUNE SYSTEM
Some people think that on early stages HIV infection does not affect the immune system much. They believe that any damage done to their immune systems can be repaired by taking antiretroviral therapy (ART). It is not true!

Up to 60% of infection-fighting CD4 memory cells become infected during acute infection, and 14 days after infection, up to half of all CD4 memory cells can be killed. In addition, HIV rapidly reduces the thymus' ability to replace dead CD4 cells. The inner layer of the intestine - an important part of the immune system - is also damaged very quickly. This can happen before the test shows the presence of HIV.

RISK OF INFECTION TO OTHERS
In acute HIV infection, the amount of HIV in the blood is much higher than subsequently. Contact with human blood acute phase infections with more more likely to lead to infection than contact with the blood of a person who has been infected for a long time. One study found that people with acute HIV infection are about 20 times more likely to become infected.

The risk of sexual transmission of HIV is also much higher initial stage acute infection.

TREATMENT OF ACUTE HIV INFECTION
The immune system produces white blood cells that recognize and kill HIV-infected cells. This is called "HIV-Specific Response". Over time, this response disappears for most people. If they are not taking antiretroviral drugs (ARVs), HIV infection will progress.

Recommendations for the use of HIV drugs recommend waiting until the immune system shows signs of damage. However, initiation of ARV therapy during acute HIV infection may protect the HIV-specific immune response.

The researchers studied patients who started treatment during an acute infection and then stopped taking antiretroviral drugs. One study showed that such treatment may delay the need to start ART treatment. Research in this area is ongoing.

PROS AND CONS OF TREATMENT OF ACUTE HIV INFECTION
Starting ART is one of the most important decisions. Anyone considering taking ARVs should carefully consider the advantages and disadvantages.
Taking ART will change your everyday life. Missed doses of a drug contribute to the development of viral drug resistance, which limits future treatment options. Fact Sheet 405 has more information on the importance of correct reception ARV.

The drugs are very strong. They call side effects, which can make life difficult for you for a long time, and they can also be very expensive.

Timely treatment can protect the immune system from the weakening caused by HIV. The weakening of the immune system is expressed as a decrease in the number of CD4 cells and an increase viral load. It is associated with increased rates morbidity. Older people (over 40) have a weakened immune system. They do not respond as well as young people to ARV therapy.

However, not all those who become infected with HIV fall ill immediately. Those with a CD4 count above 350 and a viral load below 20,000 have a 50% chance of remaining healthy for 6 to 9 years, even if they are not on ART. Fact Sheet 124 has more information about CD4 cell tests, and Fact Sheet 125 gives information about viral load.

Initially, the researchers believed that early treatment could allow a patient to stop taking ART after a period of fighting HIV. However, new data indicate that this is probably not true.

TOTAL
People with acute HIV infection are not easy to identify. Some people have no symptoms. If symptoms are present, a number of other illnesses, such as the flu, may be causing them.

If you think you may have an acute stage of HIV infection, tell your doctor and get tested. Talk to your doctor about the possible benefits of starting ART during the acute stage of HIV infection.

Taking ARV therapy is one of the biggest commitments. Discuss the advantages and disadvantages of treatment with your healthcare provider and consider them carefully before making any decisions.

Partially funded by the National Library of Medicine

Description

Acute HIV infection, or primary HIV infection, or acute retroviral syndrome, is a condition that occurs in the first 2-4 weeks after infection with the human immunodeficiency virus. This is the initial stage of the disease, it continues until the body produces antibodies to HIV. During this stage, the virus multiplies at an increased rate. Unlike other viruses, the body cannot overcome HIV and the infection can live in cells long time. Over time, the virus attacks and destroys immune cells, depriving the immune system of the ability to fight other diseases and pathogens. When this happens, HIV infection can lead to the development of acquired immunodeficiency syndrome (AIDS).

Acute HIV infection is highly contagious. However, most people with acute HIV infection do not know they are infected. This may be because most people are not tested for HIV regularly, or because standard HIV antibody tests cannot detect infection at this stage.

Causes

Acute HIV infection occurs within 2-4 weeks after initial contact with the virus. Ways of spreading HIV:

• infection during blood transfusion;
• contact with infected blood or fluids;
• contaminated syringes or needles;
• oral, anal or vaginal sexual contact;
• transmission of the virus from mother to fetus during pregnancy;
• breast-feeding.

HIV is not spread through ordinary contact such as hugging, shaking hands, sharing utensils.

Risks

Acute HIV infection does not always develop into symptomatic infection or AIDS. In some people, HIV infection may remain hidden for years or decades. Other people may never develop AIDS at all.

It must be remembered that HIV affects people of any age, race or sexual orientation. However, certain groups have an increased risk of HIV. These include:

• people who use drugs intravenously;
• homosexuals;
• African Americans.

Symptoms

Symptoms

Many people with acute HIV infection may not have symptoms. If symptoms of acute HIV infection appear, they can last from a few days to four weeks.

Most people with symptoms of acute HIV infection are unaware that their condition is related to HIV. This is because the symptoms of HIV are similar to those of the flu or other viral diseases. These include:

• rash;
• loss of appetite;
• increase in body temperature;
• headache;
• fatigue;
• pain or general malaise (illness);
• sore throat;
• night sweats;
• ulcers in oral cavity, esophagus or on the genitals;
• increase lymph nodes;
• muscle pain.

The Centers for Disease Control and Prevention estimates that 20% of people with HIV do not know they are infected. The only way find out if you have HIV - take a test. (CDC, 2012)

Diagnosis

If acute HIV infection is suspected, the doctor will conduct a series of tests to identify the virus.

The standard HIV screening test does not always detect it. Most screening tests look for antibodies to HIV, not the virus itself. It may take several months after infection before antibodies appear.

Tests that can look for signs of acute HIV infection include:

Treatment

Proper treatment is essential for people with HIV infection. Once diagnosed with HIV, it is important to learn as much as possible about the virus.

Doctors and scientists continue to debate whether early aggressive treatment should be used in all people with HIV. Early Treatment may reduce the effect of the virus on the immune system. However, long-term use of HIV medicines can cause serious side effects. Everything needs to be discussed with the doctor. possible options treatment and potential side effects to determine the most appropriate.

In addition to drug therapy your doctor may recommend the following:

• eat healthy, balanced food to strengthen the immune system;
• practice safe sex to avoid passing the virus to others and reduce your own risk of infection sexually transmitted diseases;
• avoid stress, which can weaken the immune system;
• avoid contact with people who have infectious diseases, which will be difficult to deal with;
• perform regularly physical exercise;
• avoid situations that can cause depression;
• keep active and engage in hobbies.

Complications

Complications

Over time, HIV can cause suppression of the immune system. This will make the patient susceptible to infections, the development of cancer and other diseases.

In some people, HIV infection will gradually develop into AIDS. This risk can be reduced with regular medication.

Forecast

HIV is a chronic lifelong condition. It can be treated, but it cannot be cured.

At proper treatment people with HIV can live full lives for a long time.

Prevention

Prevention

HIV can be prevented by avoiding contact with potentially infectious fluids. These include blood, semen and breast milk. healthy image life will also reduce the risk of HIV infection.

• Safe sex should always be practiced, even in relationships with one partner and negative test for HIV within the past six months.
• Avoid intravenous administration narcotic drugs. If this cannot be stopped, the risk of contracting HIV can be reduced by using only disposable needles. Many cities have needle exchange programs.
• Observe universal precautions. It should always be assumed that the blood may be infected. Protect yourself with latex gloves and other barrier methods.
• Get tested for HIV. If the test is negative, preventive measures help you stay in that state. If the HIV test is positive, it will help find treatments and reduce the risk of spreading the infection. The CDC recommends annual sexual examinations. active people who have multiple partners, people who use intravenous drugs, and people who have sexual relations with HIV-infected people. The CDC recommends that you get retested if you or your partner had one or more sexual partners since your last HIV test.

People with HIV cannot donate blood, sperm, or organs. This will help prevent the spread of HIV. However, HIV is not spread through casual contact. HIV should not affect your daily activities.

HIV infection is a stage-developing, progressive disease with damage to various systems and organs caused by the direct action of HIV, secondary infection (opportunistic and obligately pathogenic), tumor and autoimmune processes.

In our country we use clinical classification HIV infection, proposed by Acad. V. I. Pokrovsky, according to which the following stages and phases of the disease are distinguished:

I. Stage of incubation.

II. Stage of primary manifestations. A. Acute febrile phase. B. Asymptomatic phase. B. Persistent generalized lymphadenopathy.

III. Stage secondary diseases.

A. Weight loss less than 10%, superficial fungal, bacterial or viral lesions of the skin and mucous membranes, herpes zoster, repeated pharyngitis, sinusitis.

B. Progressive weight loss of more than 10%, unexplained diarrhea or fever for more than one month, "hairy" leukoplakia of the tongue, pulmonary tuberculosis, repeated or persistent bacterial, fungal, viral and protozoal lesions of the skin and mucous membranes, recurrent or disseminated herpes zoster, localized form Kaposi's sarcomas.

IV. Terminal stage.

Introduction to the classification system of the stage of incubation, which includes the period from the moment of infection to the response of the organism to it, in the form of the appearance clinical manifestations and / or the production of antibodies, due to our practice of monitoring people who had epidemiologically significant contact with HIV infection. When using methods that make it possible to detect a virus or its fragments in the body of an infected person, it is possible to diagnose the disease at this stage as well.

The stage of primary manifestations includes conditions caused directly by the interaction of the macroorganism with HIV.

Accession against the background of persistent immunodeficiency of secondary pathogens and the appearance of tumors indicates the transition of the disease to the stage of secondary diseases. The terminal stage can develop not only as a result of the progression of conditions characteristic of stage 3B, but due to CNS damage not mediated by pathogens other than HIV.

Thus, this classification can include all manifestations of the disease from the moment of infection to the death of the patient, including those that may not yet be known.

The incubation period lasts from 2 weeks to 2 months, sometimes up to 6 months.

The stage of primary manifestations in the acute phase of the disease often proceeds without clear clinical symptoms, but 30-50% of those infected develop symptoms of acute HIV infection ("acute retroviral syndrome"), most often manifesting as a "mononucleosis-like", "flu-like" or "exanthematous" illness. In these cases, the acute febrile phase of the disease is accompanied by: fever (in 96%), lymphadenopathy (in 74%), erythematous and maculopapular rash on the face, trunk, sometimes on the extremities (in 70%), myalgia or arthralgia (in 54%). Less common are other symptoms such as diarrhea, headache, nausea and vomiting, and enlargement of the liver and spleen. Neurological symptoms occur in approximately 12% of patients and are characterized by the development of meningo-encephalitis or aseptic meningitis, which have a benign course. The duration of the acute febrile phase is usually 1-3 weeks.

Acute HIV infection often goes unrecognized because of its similarity to the symptoms of influenza, infectious mononucleosis, and other common infections. In addition, some patients are asymptomatic. To confirm the diagnosis of acute HIV infection, it is advisable to determine HIV RNA using polymerase chain reaction or p24 antigen. Antibodies to HIV during this period may not be detected, they appear later, 1-3 months after infection.

Acute HIV infection usually becomes asymptomatic. The next period begins - an asymptomatic phase lasting several years (from 1 to 8 years, sometimes more), when a person considers himself healthy, leads a normal life, being a source of infection.

Much less often, after an acute infection, the stage of persistent ageneralizoic lymphadenopathy (PGL) begins, and in exceptional cases the disease progresses immediately to the stage of AIDS.

PGL is characterized by an increase in lymph nodes in two or more groups (with the exception of inguinal lymph nodes in adults), lasting at least 3 months. At the same time, enlarged lymph nodes reach a diameter of 1 cm or more in adults and 0.5 cm in children. The most frequently enlarged cervical, occipital, axillary lymph nodes. They are painless, elastic, not soldered to the underlying tissue, the skin over them is not changed. The PGL stage also lasts quite a long time - up to 5-8 years, during which the lymph nodes can decrease and increase again. During this period, there is a gradual decrease in the level of CO4-lymphocytes, on average at a rate of 50-70 cells per 1 mm3 per year. At the stages of asymptomatic infection and PHF, patients, as a rule, do not go to doctors and are detected during a random examination.

Following these stages, total duration which can vary from 2-3 to 10-15 years, the stage of secondary diseases begins (chronic clinically manifested phase of HIV infection), which is characterized by various infections viral, bacterial, fungal nature, which at first proceed quite favorably and are stopped by the usual therapeutic agents. There are repeated diseases of the upper respiratory tract- otitis, sinusitis, tracheobronchitis, etc., superficial skin lesions - localized mucocutaneous form of recurrent herpes simplex, recurrent herpes zoster, candidiasis of the mucous membranes, ringworm, seborrhea, etc.

Then these changes become deeper, do not respond to standard methods of treatment, becoming stubborn, protracted. A person begins to lose weight, weight loss reaches more than 10%, fever, night sweats, diarrhea appear.

Against the background of increasing immunosuppression, severe progressive forms of the disease develop, which do not occur in a person with a normally functioning immune system. These are the diseases that the WHO has defined as AIDS-marker, AIDS-indicator.

The classification of HIV infection proposed by the Center for Disease Control (CDC, USA) in 1993 for adults and adolescents included clinical and laboratory criteria for identifying the main categories of people with this infection. The same principle formed the basis for the classification of the disease in children (CDC, 1994).

Classification of HIV infection in adults (CDC, 1993)

acute (primary) HIV infection;

asymptomatic carrier of HIV;

persistent generalized lymphadenopathy (enlargement of lymph nodes> 1 cm in two anatomically unrelated regions, excluding inguinal, lasting more than 3 months.

Clinical category B:

bacillary angiomatosis;

oral or vulvovaginal candidiasis that persists for more than 1 month or is difficult to treat (the occurrence of a relapse after the end of treatment within three months);

herpes zoster - an infection with lesions only of the skin, recurring within 1 year or a single episode with damage to the internal organs;

listeriosis;

inflammatory diseases of the pelvic organs with a tendency or the formation of tubo-ovarian abscesses;

severe cervical dysplasia or cervical carcinoma in situ;

one of two constitutional symptoms:

a) documented fever with body temperature above 38.5 ˚ With a duration of more than 1 month, which can only be explained as associated with HIV infection;

b) persistent diarrhea for more than 1 month, which can only be explained as associated with HIV infection.

idiopathic thrombocytopenic purpura;

- an infection caused by the herpes simplex virus that causes a mucocutaneous ulcer that persists for more than 1 month, or bronchitis, pneumonia or esophagitis of any duration;

- cytomegalovirus lesions of organs other than the liver, spleen and lymph nodes, for example, chorioretinitis, colitis;

- Kaposi's sarcoma in persons younger than 60 years;

- brain lymphoma (primary) in persons younger than 60 years;

- other, non-Hodgkin's disease type of B-cell lymphoma or unknown immunological phenotype;

- malignant cervical carcinoma;

- pulmonary or extrapulmonary tuberculosis;

- atypical mycobacteriosis caused by a complex of Mycobacterium avium or Mycobacterium kansasii, or other Mycobacterium spp., or undifferentiated Mycobacterium, disseminated (in organs other than the skin, lungs, lymph nodes of the neck, lung root, or in combination with a lesion in these areas);

- recurrent septicemia caused by "non-typhoid" Salmonella serovars;

- repeated, within 1 year, pneumonia, confirmed radiologically and with radiographically documented recovery between the first and second episode, especially if it is caused by Streptococcus pneumoniae, Haemophilus in-fluenzae, Staphylococcus aureus and gram negative microorganisms: Enterobacteriaceae, Pseudomonas;

- pneumonia caused by Pneumocystis carinii;

- central toxoplasmosis nervous system;

- cryptosporidiosis with diarrhea lasting more than 1 month;

- isosporosis with diarrhea, lasting more than 1 month;

- candidiasis of the esophagus, trachea, bronchi or lungs;

- extrapulmonary cryptococcosis;

- coccidioid mycosis, disseminated (in organs other than the lungs, lymph nodes of the neck and root of the lung or in combination with lesions of these organs);

- disseminated histoplasmosis (in organs other than the lungs, lymph nodes of the neck and root of the lung or in combination with lesions of these organs);

- encephalopathy caused by HIV (clinical data on disabling conditions due to impaired cognitive abilities and (or) motor function that affect performance or activities of daily living in the absence of comorbidities or conditions other than HIV to explain these findings);

- progressive multifocal leukoencephalopathy;

- wasting syndrome with HIV infection (significant involuntary loss of body weight at a level of more than 10% of the bulk in the presence of either chronic diarrhea (liquid stool at least 2 times a day for 30 days or more), or chronic weakness and documented fever (intermittent or persistent for 30 days or more) and the absence of concomitant diseases or conditions, other than HIV infection, that could explain these data) .

Prognostic factors for the progression of HIV infection may be the results laboratory research and clinical data.

Of the laboratory data, the most important are:

Viral load, which is the clearest prognostic factor, is also the most important criterion for the effectiveness of antiretroviral therapy.

The level of CD4 T-lymphocytes. It is also one of the most important criteria disease progression. With a decrease in CD4 count of more than 7%, the risk of progression of HIV infection increases by 35 times compared with those whose CD4 level is stable. An increase in the number of CD4 cells against the background of antiretroviral therapy is a good prognostic sign.

p24 antigen. This antigen should be determined if viral load cannot be measured. for a long time positive test p24 indicates the possibility of disease progression.

Virus type. The detection of a virus that induces the formation of syncytium indicates the possibility of a decrease in the number of CD4 cells and, consequently, the progression of the disease.

Clinical symptoms:

recurrent candidiasis;

progressive diarrhea;

"hairy" leukoplakia of the tongue;

recurrent herpes zoster;

prolonged and pronounced acute retroviral syndrome;

lack of antiretroviral therapy.

Allocate patients with HIV infection, in which for a long time the disease does not progress to the stage of AIDS ("non-progressors"). This group includes patients who have a very long, more than 6 years, stable normal level CD4-KneTOK, and viral loads are low.

The introduction of antiretroviral therapy into clinical practice has made it possible to identify, along with natural flow HIV infection, HIV infection on the background of antiretroviral therapy.

Unnatural development of HIV infection (against the background of antiretroviral therapy)

highly active antiretroviral therapy- BAAPT (highly active antiretroviral therapy - HAARTj can stop the natural progression of HIV infection:

by reducing the viral load to<50 копий/мл у 50-70% больных;

due to an increase in the number of CD4 cells (by 150-200 cells) in most patients;

By improving immune status, BAAPT can prevent or even cure opportunistic infections (OIs) and even malignant tumors;

there may be no need for chemoprophylaxis and/or treatment of opportunistic infections;

increases the life expectancy of patients.

Thus, at present, due to the introduction of antiretroviral therapy, the clinical picture of HIV infection has changed significantly, the life expectancy of patients has increased, secondary AIDS-indicative diseases have become less common, and the need for their prevention against the background of antiretroviral therapy has disappeared. However, due to the fact that many patients, including drug addicts, remain without treatment and proper follow-up, the need to characterize opportunistic diseases is extremely important. It should also be taken into account that not all patients on antiretroviral therapy are amenable to treatment, and they may progress the disease with the development of opportunistic diseases.