From HIV to AIDS: stages of infection

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HIV affects your immune system, which means that other opportunistic infections can easily set in if you don’t know that you’re HIV-positive, and your CD4 cell count drops low enough to give harmful bacteria and viral cells the chance to invade your body.

This article outlines the stages of infection of HIV, all the way through to AIDS.

How long does it take for HIV to develop into AIDS?

The time of seroconversion (HIV infection) to AIDS, and eventually death, varies from one person to another. It’s influenced by important things like getting tested, adhering to HIV treatment and practicing safe lifestyle choices. There is, however, a pattern that has been observed among people living with HIV, in terms of the time it takes to develop AIDS:

• Rapid progressors take 1-3 years.*
• Average progressors take 8-10 years.*
• Slow progressors take 15 years.

*These figures have been taken from the NCBI and are understood to reflect a progressive timeline for HIV-positive people who do not take ARVs.

There is a small group of people who are classified as non-progressors. The slow progression of these individuals is thought to be as a result of genetically inherited factors.

What factors affect the progression of HIV into AIDS?

There are a number of factors which influence the progression of HIV for every infected person. These include:

• Nature of transmission (e.g. needle-stick injury in the hospital; sexual transmission etc.)
• Incubation period of the virus in the bloodstream.
• The number of viral particles transferred from the HIV-positive person to the other.
• Any simultaneous viral or bacterial infection.
• The strain of virus being transmitted.
• Biochemical abnormalities, (e.g. glutathione peptide deficiency).
• Age (people aged below 10 or over 30 develop AIDS faster than adolescents or young adults, possibly due to immune system variations).
• Heredity and genetic make-up.
• Immunosuppressive behaviour (e.g. substance/narcotic abuse).
• Access and commitment to, and discipline over, ARVs and/or a prescribed HIV treatment plan.

How long can you live with HIV?

There are so many factors involved in providing an answer to a question like this. Of all of these, risk exposure levels, treatment adherence and lifestyle choices stand out. This is what we know: 

• Five years after exposure, approximately 15% of HIV-positive people will have progressed to AIDS.
• Of those which progressed to AIDS, half would have died, by the end of those same five years.
• Of the remaining 85% of HIV-positive people, less than one third will have constitutional symptoms of infection.
• Less than two thirds of that 85% will be completely asymptomatic.
• The remaining in-betweeners are most likely to only have lymphadenopathy.
• 10 years after exposure, 50% will have progressed and deteriorated.
• 80% of those who deteriorate by this time will have succumbed.
• Of the 50% who have not progressed to AIDS, one half will have constitutional symptoms.
• One third will only have lymphadenopathy.
• The rest will be asymptomatic with CD4 cell counts ranging between 200-500.

What is the process of HIV becoming AIDS?

As mentioned in our article defining what HIV is, there is a process, and there are several stages of infection:

1. Acute infection
2. Asymptomatic disease (silent phase)
3. Early symptomatic disease
4. AIDS

The first stage of HIV: acute infection.

Acute infection can occur through exposure to the bodily fluids of an infected person. Any behaviour that involves you being or becoming exposed to someone else’s bodily fluids carries a risk of infection.

The most common methods of HIV transmission are unprotected sexual activity and the sharing of needles, especially by drug users. Additionally, HIV-positive pregnant women, women in labour and those breastfeeding their babies are also able to infect their children.

How is HIV transmitted?

While we do have a detailed article on the methods of HIV transmission, we feel it’s important to include a summary here too. This is because HIV can be spread from one person to another while still in its first stage of acute infection. In South Africa, HIV is mainly spread through sexual activity and the sharing of needles.

Previously, mother-to-child transmission was a major challenge, but our Prevention of Mother-To-Child Transmission (PMTCT) programme has been so effective, that this is no longer the mammoth concern that it once was.

The second stage of HIV: the asymptomatic silent phase

Following infection, there is a period of intense, unchecked viral replication. This happens 2 to 4 weeks after infection, and the replication activity lasts 1 to 2 weeks. It’s after this process that the infected person recovers and is henceforth referred to as ‘seropositive’ for HIV antibodies.

Though HIV replication is massive, most patients only experience moderate flu-like symptoms at this stage. Typically, the illness is sudden in onset and is characterised by fever, swelling of the lymph glands, a measles-like rash all over the body, ulcers in the mouth and sometimes on the genitalia.

Disease of the gastrointestinal tract is often involved, manifesting as nausea, vomiting and/or diarrhoea. Infected persons may also present inflammation of the pharynx and dysphasia, meningitis or encephalitis.

This acute HIV syndrome does not occur in all individuals infected with the virus, and many individuals who are HIV-positive, do not recall ever having experienced the illness. It has been estimated that approximately 50–70% of individuals who are HIV-positive experience acute HIV illness. This syndrome is rarely seen in children.

The third stage of HIV: early symptomatic disease

During this, the third stage of infection, your immune system is engaged in a constant battle with the rapidly replicating virus. Approximately 50 million to 2 billion new virus particles are created each day. The immune system responds by replenishing the peripheral blood with up to 2 billion new CD4 cells per day.

The immune system can hold HIV in check for many years, but will eventually begin to lose the battle. The virus begins to destroy the CD4 cell population. As that happens, the CD4 counts continue to drop, and signs and symptoms more specific to HIV/AIDS arise.

These signs and symptoms are:

• Persistent generalised lymphadenopathy (enlarged, painless, non-tender lymph nodes).
• Oral lesions (thrush, leukoplakia, ulcers).
• Shingles (painful rash affecting a defined area of skin).
• Thrombocytopenia (reduced platelet count).
• Early stages of neurological disease (aseptic meningitis/peripheral neuropathy).

The fourth stage: full-blown AIDS

Over the years, the diagnostic elements of this end-stage of HIV infection have undergone various changes under different classification systems. The advent of AIDS marks an important milestone in the course of the infection. Although very few people try to, and successfully do, bounce back by following a strict treatment plan, AIDS is still referred to as an irreversible diagnosis.

Recovery from individual opportunistic infections may occur, including a state of remission for cancerous tumours. Recurrence, however, can be both more frequent and intense. AIDS becomes more and more difficult to treat until finally, the infected person succumbs. This happens 18-24 months after the onset of AIDS.

Essentially, the components of AIDS consist of the direct consequences of damage by HIV, as well as the indirect consequences of immunosuppression.

How do you know if you have AIDS?

In an official medical sense, AIDS is diagnosed when:

• An individual tests HIV-positive
• The respective HIV-positive individual has a CD4 cell count of less than or equal to 200cells/mm³
• 20 or more opportunistic infections are present in the respective HIV-positive person’s body

It may not be that all ‘qualifying’ criteria for the diagnosis of AIDS occurs simultaneously in the same person.

What infections are associated with HIV/AIDS?

HIV and AIDS are conditions or states, that affect people who test positive for HIV, the viral organism. Both conditions, HIV and AIDS, may enable the exact same opportunistic infections to set in, but it will be more likely that an AIDS patient will present more intense symptoms than an HIV patient. Some of the AIDS-defining infections include:

• Kaposi’s sarcoma
• Pneumocystis carinii pneumonia
• Retinitis due to cytomegalovirus
• Meningitis/encephalitis due to cryptococcal or toxoplasmosis infection
• Pulmonary, miliary or extrapulmonary tuberculosis
• Dementia for no other reason (HIV encephalopathy)
• Cancers such as lymphoma (enlargement of lymph nodes, liver and/or spleen).

How many HIV-positive people die from AIDS?

Because of the constant developments in medical science, there’s no specific time window that is ever settled on for an extended period of time. Many factors also affect the answer to a question like this, such as lifestyle choices and treatment adherence. What we currently estimate is that 80% of people living with AIDS today will succumb to secondary infections.

Sources

PMC. 2015. Rapid HIV Progression During Acute HIV-1 Subtype C Infection in a Mozambican Patient with Atypical Seroconversion. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4385758/ [Accessed 14 August 2020]

ScienceDirect. 2010. Acute HIV infection with rapid progression to AIDS. Available at: https://www.sciencedirect.com/science/article/pii/S1413867010700593 [Accessed 14 August 2020]

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