Acute (Primary) HIV

During the few weeks after first getting infected with Human Immunodeficiency Virus (HIV), about 50% to 80% have a group of symptoms.  Most have fever, “swollen glands” (generalized, not just in the neck; see lymph nodes), sore throat (without pus on the tonsils), feel lousy or fatigued,  maybe get a splotchy rash, muscle or joint aches, maybe mouth sores.  It’s called a “mononucleosis syndrome” because it feels like Mono.

A minority of people get a “viral meningitis syndrome” instead.ย  This consists of fever and headache with stiff neck (though not as bad as true bacterial meningitis).ย  They may also have weakness of the face (“Bell’s Palsy“), on one or even both sides.

These symptoms occur around 1 to 4 weeks after getting infected (usually between 2 and 3 weeks).  They last for 1 to 3 weeks, then go away on their own.

The usual HIV antibody test (used in home tests) is often negative during this phase, known as the “window period.”ย  If the “4th Generation” test is used (standard now at most labs), it will turn positive around 3 weeks after getting infected.ย  But the best test to use is the “HIV Viral Load,” which is positive at 1 week from infection, and rises very high during Acute HIV symptoms.

This very first month of HIV infection is important because patients are extremely contagious.  About 50% of all new HIV infections are acquired from patients who are in this phase (actually, from patients who are in their first 3-4 months of having HIV).  Anybody diagnosed with Acute (also called “Primary”) HIV should either avoid sex, or use condoms and be very careful.  If they inject drugs, they shouldn’t share needles or the “works” used for preparation.

HIV treatment is now recommended for Acute (Primary) HIV.ย  It eases symptoms, makes transmission harder, and may help protect the immune system in the long run (instead of starting treatment later).ย  And many people feel comforted that they’re taking a positive step to protect themselves and others. However, certain conditions are absolutely necessary to start medication:

  • A blood test is obtained to see if the person’s particular strain of HIV is resistant to any medications (“resistance test,” “Genotype”)
  • The person is committed to taking daily medication right on schedule, without missing doses (missing doses can allow the virus to become resistant to the medications, which then will never work again)
  • The person is committed to lifetime treatment
  • The person understands there’s no proof that starting absolutely immediately will make any difference between waiting a few weeks (nobody should feel “forced” into beginning medication).

If a person has doubt about beginning medication, they should wait.ย  But they should still get a resistance test (“Genotype”) performed.ย  That way, when they do decide to start, they’ll know exactly what medicines will and won’t work.ย  The longer they wait to get this test done, the less accurate it may be.ย  And they should be very careful not to pass the virus (see above).

See also discussion of HIV in general.

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