Human Immunodeficiency Virus (HIV) Primary Infection

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Overview

Primary HIV infection (PHI) is an illness that can develop when a person becomes infected with HIV, also known as the virus that leads to AIDS. PHI occurs in about half of people who are exposed to HIV; it develops in weeks to months after infection with HIV and often mimics the flu with fatigue, muscle aches, swollen glands, nausea, vomiting, and diarrhea. It is very difficult to tell the difference between a regular viral illness such as the flu and PHI, although only those who are at risk for exposure to HIV can develop PHI. Tell your doctor if you have had unprotected sex with an infected partner or shared needles or syringes with an infected person. It is important to know as early as possible if you have HIV because you want to protect yourself (by seeing an HIV specialist and perhaps beginning a regimen of antiviral drugs) and protect others. There is no cure for HIV or AIDS.

The HIV virus lives in some body fluids (blood, semen, vaginal fluid, and breast milk) but not others (sweat, tears, or urine). It is transmitted when the former types of fluids are spread to another person by oral, anal, or vaginal sex; breast-feeding; or intravenous drug use. HIV can also be passed from a mother to a baby, either during the pregnancy or delivery.

Who's at risk?

Almost a billion Americans are infected with HIV; more than a quarter of these people may not know they are infected. In this country, African Americans and Hispanics are infected 7 and 3 times more often, respectively, than whites.

Other risk factors associated with HIV infection include having multiple sex partners, having other sexually transmitted diseases, and having had a transfusion with blood or blood products prior to 1985.

Signs and Symptoms

A temporary (transient) rash of small, pink-to-red spots primarily involves the trunk. Patients usually notice swollen lymph nodes, fever, headache, nausea, and/or diarrhea, as well as a sore throat. Other symptoms include vomiting, joint paints (arthralgias), and sensitivity to light (photophobia). Males may notice ulcers in the mouth or on the penis.

Self-Care Guidelines

Even without symptoms, you can pass (transmit) the virus to others. Patients with PHI are 10 times more likely to transmit HIV than will patients who are in the chronic phase of HIV infection. If you think you might have been exposed to someone with HIV or if you have any of the known risk factors yourself (see the list under "Who Gets It"), avoid sexual activity, stop using needles to inject street drugs, and seek medical care and testing.

If you are infected, find a competent doctor who understands HIV. Eat healthy food. Keep up with immunizations. Avoid smoking and illegal drug use. Get enough exercise and rest. And you should also avoid other infections your immune system might have trouble fighting. You can do this by washing your hands thoroughly and often, by learning how to deal with pets and other animals, by avoiding unpasteurized or raw foods, and by drinking pure water.

If you choose to use any over-the-counter medicine or supplements or alternative medicine practices, such as acupuncture, be sure to let your doctor know about them.

When to Seek Medical Care

Any individual with flu-like symptoms and/or risk factors for HIV (see the list under "Who Gets It") should avoid sexual activity, stop any non-medical needle use, and seek medical care and testing.

Treatments Your Physician May Prescribe

Your doctor will base diagnosis on your symptoms and signs as well as the likelihood that you may be in a high-risk group, such as people who are sexually promiscuous, use illicit intravenous drugs, or engage in unprotected or unsafe sex, especially men who have sex with men.

PHI occurs before an individual develops sufficient HIV antibodies needed to test positive on a blood test. These antibodies can take 2–4 months to develop. Therefore, repeated HIV-antibody blood tests over time are recommended when an individual is very likely to be infected.

Any person with PHI should notify sexual partner(s) immediately. Doctors are required by law in most states to report HIV infections to the public health department.

A number of drugs have been developed to treat HIV and infections. Although a cure is not possible, people with HIV infection live longer now and enjoy a much better quality of life than they did in the early years of HIV awareness. Treatment is tailored for each person to make it as simple, effective, and with as few side effects as possible, and this often involves taking a mixture of medications, carefully overseen by your doctor.

Trusted Links

Clinical Information and Differential Diagnosis of Human Immunodeficiency Virus (HIV) Primary Infection

References

Bolognia, Jean L., ed. Dermatology, pp.1199-1214. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp.1238-2148. New York: McGraw-Hill, 2003.