HIV Symptom Free Period

Becoming infected with HIV and becoming sick from AIDS are two different events. For most people, it takes many years from the time someone is infected with HIV to the time that they develop symptoms of AIDS. Some people get sick sooner and others stay well longer, especially with treatment. However, there is almost always a significant period of time after infection when an HIV-positive individual will have no symptoms at all -- often 10 years or more.

Keeping in mind the two separate events (becoming HIV-infected vs. actually developing AIDS) can help you to remember that there are also two separate time periods when someone may show symptoms related to HIV-infection.

HIV Early Symptoms

What are the early symptoms of HIV/AIDS?

Many people do not develop any symptoms when they first become infected with HIV. Some people, however, get a flu-like illness within three to six weeks after exposure to the virus. This illness, called Acute HIV Syndrome, may include fever, headache, tiredness, nausea, diarrhoea and enlarged lymph nodes (organs of the immune system that can be felt in the neck, armpits and groin). These symptoms usually disappear within a week to a month and are often mistaken for another viral infection.

During this period, the quantity of the virus in the body will be high and it spreads to different parts, particularly the lymphoid tissue. At this stage, the infected person is more likely to pass on the infection to others. The viral quantity then drops as the body's immune system launches an orchestrated fight.

More persistent or severe symptoms may not surface for several years, even a decade or more, after HIV first enters the body in adults, or within two years in children born with the virus. This period of "asymptomatic" infection varies from individual to individual. Some people may begin to have symptoms as soon as a few months, while others may be symptom-free for more than 10 years. However, during the "asymptomatic" period, the virus will be actively multiplying, infecting, and killing cells of the immune system.

Once HIV enters the human body, it attaches itself to a White Blood Cell (WBC) called CD4. Also, called T4 cells, they are the main disease fighters of the body. Whenever there is an infection, CD4 cells lead the infection-fighting army of the body to protect it from falling sick. Damage of these cells, hence can affect a person's disease-fighting capability and general health.

After making a foothold on the CD4 cell, the virus injects its RNA into the cell. The RNA then gets attached to the DNA of the host cell and thus becomes part of the cell's genetic material. It is a virtual takeover of the cell. Using the cell's division mechanism, the virus now replicates and churns out hundreds of thousands of its own copies. These cells then enter the blood stream, get attached to other CD4 cells and continue replicating. As a result, the number of the virus in the blood rises and that of the CD4 cells declines.

Because of this process, immediately after infection, the viral load of an infected individual will be very high and the number of CD4, low. But, after a while, the body's immune system responds vigorously by producing more and more CD4 cells to fight the virus. Much of the virus gets removed from the blood. To fight the fast-replicating virus, as many as a billion CD4 cells are produced every day, but the virus too increases on a similar scale. The battle between the virus and the CD4 cells continues even as the infected person remains symptom-free.

But after a few years, which can last up to a decade or even more, when the number of the virus in the body rises to very high levels, the body's immune mechanism finds it difficult to carry on with the battle. The balance shifts in favour of the virus and the person becomes more susceptible to various infections. These infections are called Opportunistic Infections because they swarm the body using the opportunity of its low immunity. At this stage, the number of CD4 cells per millilitre of blood (called CD4 Count), which ranges between 500 to 1,500 in a healthy individual, falls below 200. The Viral Load, the quantity of the virus in the blood, will be very high at this stage.

Opportunistic infections are caused by bacteria, virus, fungi and parasites. Some of the common opportunistic infections that affect HIV positive persons are: Mycobacterium avium complex (MAC), Tuberculosis (TB), Salmonellosis, Bacillary Angiomatosis (all caused by bacteria); Cytomegalovirus (CMV), Viral hepatitis, Herpes, Human papillomavirus (HPV), Progressive multifocal leukoencephalopathy (PML) (caused by virus); Candidiasis, Cryptococcal meningitis (caused by fungus) and Pneumocystis Carinii pneumonia (PCP). Toxoplasmosis. Cryptosporidiosis (caused by parasites). HIV positive persons are also prone to cancers like Kaposi's sarcoma and lymphoma.

The Center for Disease Control (CDC), Atlanta has listed a series of diseases as AIDS-defining. When these diseases appear, it is a sign that the infected individual has entered the later stage of HIV infection and has started developing AIDS. The progression of HIV positive persons into the AIDS stage is highly individual. Some people can reach the AIDS stage in about five years, while some remain disease free for more than a decade. Measurement of the viral load and the CD4 count helps a doctor in assessing an infected person's health condition.

Later Symptoms of HIV

Following are the later symptoms of HIV:

Lack of energy
Weight loss
Frequent fevers and sweats
A thick, whitish coating of the tongue or mouth (thrush) that is caused by a yeast infection and sometimes accompanied by a sore throat
Severe or recurring vaginal yeast infections
Chronic pelvic inflammatory disease or severe and frequent infections like herpes zoster
Periods of extreme and unexplained fatigue that may be combined with headaches, lightheadedness, and/or dizziness
Rapid loss of more than 10 pounds of weight that is not due to increased physical exercise or dieting
Bruising more easily than normal
Long-lasting bouts of diarrhoea
Swelling or hardening of glands located in the throat, armpit, or groin
Periods of continued, deep, dry coughing
Increasing shortness of breath
The appearance of discoloured or purplish growths on the skin or inside the mouth
Unexplained bleeding from growths on the skin, from mucous membranes, or from any opening in the body
Recurring or unusual skin rashes
Severe numbness or pain in the hands or feet, the loss of muscle control and reflex, paralysis or loss of muscular strength
An altered state of consciousness, personality change, or mental deterioration
Children may grow slowly or fall sick frequently. HIV positive persons are also found to be more vulnerable to some cancers.

AIDS Symptoms

HIV virus causing AIDS enters the blood and quickly penetrates white cells. Then they program the white cells, after which there is often little or no trace of the AIDS virus at all. This situation usually lasts for six to twelve weeks. During this time the person is free of HIV or AIDS symptoms and antibody tests for AIDS and HIV are negative.

First Symptoms of AIDS Illness (HIV Infection)
First thing that starts developing in a flu like illness, which may look like glandular fever with swollen glands in the neck and armpits. At this stage the blood test will usually become positive as it picks up the tell-tale antibodies. Most people do not realise what is happening, although when they later develop AIDS they look back and remember it clearly. Most people have produced antibodies in about twelve weeks.

Latent infection
The person in this stage has a positive HIV test. The virus often seems to disappear completely from the blood again. At least nine out of ten who see these HIV and AIDS symptoms will develop further problems.

San Francisco studies show that in developed countries, without use of the latest therapies:

50% with HIV develop AIDS in ten years
70% with HIV develop AIDS in fourteen years
Of those with AIDS, 94% are dead in five years

The next HIV AIDS symptoms stage begins when the immune system starts to break down. This is often preceded by subtle mutations in the virus, during which it becomes more aggressive in damaging white cells. Several glands in the neck and armpits may swell and remain swollen for more than three months without any explanation. This is known as persistent generalised lymphadenopathy (PGL).

Early HIV Virus Progression
As the HIV disease progresses, the person starts showin up other AIDS symptoms. A simple boil or warts may spread all over the body. The mouth may become infected by thrush (thick white coating), or may develop some other problem. Dentists are often the first to be in a position to make the diagnosis. People may develop severe shingles (painful blisters in a band of red skin), or herpes. They may feel overwhelmingly tired all the time, have high temperatures, drenching night sweats, lose more than 10% of their body weight, and have diarrhoea lasting more than a month. No other cause is found and a blood test will usually be positive. Some used to call this stage ARC, or AIDS related complex.

Late HIV Illness - The AIDS Symptoms

The final stage is AIDS. Most of the immune system is intact and the body can deal with most infections, but one or two more unusual infections become almost impossible for the body to get rid of without medical help, usually intensive antibiotics.

These infections can be a nightmare for doctors and patients. The desperate struggle is to find the new germ, identify it, and give the right drug in huge doses to kill it. The germ may be hiding deep in a lung requiring a tube (bronchoscope) to be put down the windpipe into the lung to get a sample. The person is sedated for this. It may be hiding in the fluid covering the brain and spinal cord, requiring a needle to be put into the spine (lumbar puncture). It may be hiding in the brain itself. It may hide in the liver or gall-bladder or bowel. It can hide anywhere.