Within 2 to 4 weeks after the HIV contraction develops the condition known as an acute HIV infection.
HIV infection is rarely diagnosed at this stage as the symptoms are non-specific and remind flu or mononucleosis. Nonetheless, primary HIV infection is contagious, so the infected person may infect the others having no idea about it. It was estimated that approximately 1,2 million of HIV-positive individuals don’t know that they are ill.
The human immunodeficiency virus is a retrovirus (Retroviridae family) that contains RNA and affects the immune system by attacking CD4+ T-lymphocytes, macrophages and dendritic cells. HIV attaches to the CD 4+ receptors expressed on the surface of these cells and enters their nucleus where with the help of the enzyme reverse transcriptase synthesizes DNA and replicates. Occurs viremia and the HIV spreads throughout the body.
There are two types of HIV distinguished – HIV-1 and HIV-2. HIV-1 is more common, whereas HIV-2 is mainly found in West Africa.
When HIV enters the bloodstream and spreads in the body, the immune system is not prepared to fight against the infection. This stage of HIV infection last until the body creates antibodies against HIV.
Acute retroviral syndrome is characterized by the various non-specific symptoms.
Flu-like/mononucleosis-like symptoms of acute HIV infection include:
- Fatigue and general malaise;
- Muscle pain (myalgia);
- Sore throat;
- Joint pain;
- Lymphadenopathy (enlargement of the lymph nodes);
- Night sweats;
- Increased body temperature, fever and chills;
- Unexplained weight loss;
- Maculopapular rash;
- Enlargement of the spleen and liver;
- Nausea and vomiting;
- Loss of appetite;
These symptoms may last for a few days or up to four weeks. However, not all of the infected individuals experience the symptoms of seroconversion syndrome.
HIV is usually diagnosed by performing serum tests which detect the presence of HIV antibodies. Albeit these tests won’t be useful in acute HIV infection as it takes several months for the antibodies to be found in the serum.
To diagnose acute retroviral syndrome the presence of HIV in the blood should be detected. The following tests may be helpful:
- p24 antigen blood test;
- CD4 count and HIV RNA viral load test;
- HIV ELISA and Western blot tests;
Antiretroviral therapy is not able to kill the virus, but it slows down the virus replication and postpone the development of AIDS. The treatment should be initiated as soon as possible (even when the HIV infection is not confirmed as prophylaxis). Once the viral load decreases the risk of transmission is reduced.
The most effective is the treatment which includes the combination of anti-HIV drugs with which the patient hasn’t been treated in the past and that are not cross-resistant to other drugs that the patient has already received. Monotherapy is not recommended as drug resistance develops.
- Reverse trancriptase inhibitors
Zidovudine (300 mg bid), didanosine (125-200 mg bid), zalcitabine (0.75 mg tid), stavudine (30-40 mg bid), lamivudine (150 mg bid), abacavir (300 mg bid)
Nucleotide analogue tenofovir (300 mg qd)
Nonnucleoside reverse transcriptase inhibitors:
Nevirapine (200 mg/day for 14 days, later 200 mg bid), delavirdine (400 mig tid), and efavirenz (600 mg qhs)
- Protease inhibitors
Saquinavir (1000-1200 mg bid), indinavir (800 mg q8h), ritonavir (600 mg bid), nelfinavir (750 mg tid or1250 mg bid), amprenavir (1200 mg bid), fosamprenavir (1400 mg bid), atazanavir (400 mg qd)), tipranavir (500 mg daily), and darunavir (600 mg daily)
- Entry inhibitors (CCR5 co-receptor antagonists)
Enfuvirtide (90 mg bid), maraviroc (150-600 mg bid)
- Integrase inhibitors
Raltegravir (400 mg bid)