Symptoms and management of acute HIV infection

person in bed with the flu holding a thermometer

By David Railton   

Reviewed by Daniel Murrell, MD

Symptoms | Causes | Outlook | Managing an infection | Prevention

Acute HIV infection, also
known as “primary HIV infection,” is the first stage of HIV.

During the acute period of
infection, the level of virus in a person’s blood is very high as their body is
not yet able to mount an immune response.

Some reports describe the
initial symptoms of acute HIV infection as being like “the worst flu
ever.” These symptoms usually occur 2-4 weeks after infection and may
  • fever
  • swollen glands
  • sore throat
  • rash
  • muscle and joint aches and
  • headache
When to see a doctor

The signs of acute HIV infection
can be easily mistaken for the symptoms of different illnesses. Conventional
HIV tests may not detect acute HIV infection, so misdiagnoses are common.
If a person experiences these
symptoms and they think they may have recently been exposed to HIV, they should
speak to their doctor about what testing options are available.
How is acute HIV infection

The most common HIV tests are
unable to detect HIV at the acute infection stage. This is because the tests
are typically designed to detect the HIV-specific antibodies that are produced
by the immune system during a process called seroconversion.
It can take as little as a few
weeks or as many as a few months for a person’s body to develop these
antibodies. This means that someone who has recently been infected with HIV and
is tested during the acute infection stage may not be diagnosed as
However, a screening method
called nucleic acid amplification testing or detecting an HIV-viral load (the
amount of HIV in the bloodstream) can help to detect HIV infection in people
who have been recently infected.
Tests that use p24 antigen
detection can also help detect HIV infection before antibodies are produced.
Most people contract HIV after
coming into contact with body fluids that contain the virus.
Examples of these fluids
include blood, semen, vaginal fluids, and breast milk.
The virus is usually spread
from person to person as a result of having sex or sharing needles with someone
who has HIV.
HIV can also be transmitted
from a mother to a child, both during pregnancy, birth, and through
Risk and acute HIV infection

It is estimated that up to 50 percent
of new HIV infections are unknowingly transmitted from people who have acute
HIV infection.
Regardless of gender or sexual
preference, HIV transmission is about 7.25 times more likely during acute
infection than it is during chronic infection, which is the second stage of HIV
The HIV transmission levels
are high during the acute stage of the condition because the blood contains
high levels of the virus, but no antibodies. Since acute HIV infection is
difficult to diagnose, people with HIV may engage in high-risk behavior without
realizing that they pose a risk to other individuals.
Receptive anal sex is the
highest-risk type of sex for HIV transmission, followed by insertive anal sex,
then vaginal sex, and lastly oral sex.
A 2015 study found that, among
men who have sex with men, having unprotected, receptive anal sex was
associated with an increase for acquiring HIV infection. This risk became more
severe for men have unprotected, receptive anal sex with five or more men.
The study did not report that
use of injected or non-injected drugs was significantly associated with
increased risk of acute HIV infection. However, some other studies have found
that drugs such as methamphetamine seem to drive risky sexual behaviors and
increase risk for acute HIV infection among men who have sex with men.

Following acute HIV infection,
patients enter the second stage of infection – chronic HIV infection. During
chronic infection, HIV continues to multiply in the blood, but at lower levels
than in acute infection. Although people with chronic HIV infection may not
exhibit symptoms of HIV, they can still transmit the virus.
Without treatment, chronic
infection may progress to the final stage of HIV infection within 10 years, on
average, which is known as acquired immunodeficiency syndrome, or AIDS.
AIDS develops when a person’s
immune system has been so badly damaged by HIV that their body is unable to
fight the infections that a healthy immune system might be able to.
People with AIDS who do not
receive treatment will usually die within 3 years.
However, current treatment
strategies for HIV mean that most people with HIV will not develop AIDS but can
continue to live a full life.
Managing an infection

Medicines called
antiretroviral drugs are commonly used to manage HIV infection. Antiretrovirals
do not kill HIV or cure the condition. However, combinations of these drugs are
able to prevent the growth of the virus and reduce the viral load to
undetectable levels.
People who have an undetectable
viral load stay healthier for longer and are significantly less likely to
transmit the virus to other people compared to most people with HIV who are not
taking antiretroviral medication.
If the viral load is
undetectable that does not mean that the virus has gone or that the condition
has been cured.
It is worth noting that ART
can reduce the level of the virus in the blood to the point where it is no
longer detectable. At this level, it is no longer transmissible, according to
the Center for Disease Control and Prevention (CDC).
Increasingly, studies are
suggesting that if a person begins antiretroviral therapy (ART) within 3 months
of being diagnosed with acute phase HIV, progression of the disease is slowed
down. It also helps to slow down other possible complications such as
inflammation throughout the body.

Experts generally agree that
the following steps help reduce risk of HIV infection:

  • not injecting drugs
  • getting tested for HIV and
    knowing the status of a partner or partners
  • avoiding risky sexual
  • using condoms with every
    sexual experience
  • limiting the number of sexual
    partners – the more partners someone has, the higher the risk of
    sexually-transmitted diseases, including HIV
  • discussing prevention options
    with your doctor
One prevention option for
people at high risk of HIV is called pre-exposure prophylaxis (PrEP). This
method involves taking HIV medication every day. There are also some newer PrEP
options in clinical studies, which include receiving an injection every 8 weeks
instead of taking a pill every day. However, PrEP is currently appropriate for:

  • people who are in a sexual
    relationship with a partner who has HIV
  • men who have sex with men who
    have had anal sex without a condom in the past 6 months or have been diagnosed
    with a sexually transmitted disease in the past 6 months
  • heterosexual men and women who
    do not always use condoms during sex with partners who are at high risk of HIV
  • people that have injected
    drugs in the past 6 months and have either shared needles or been in a drug
  • people with significant,
    ongoing risk of acquiring HIV-infection
PrEP offers effective
protection against HIV infection by building up in tissues where exposure risk
is highest, and preventing HIV entry and replication. This mechanism prevents
transmission of HIV to a person who is not infected[MD(1] .
Condoms continue to be an
important method for reducing the risk of spreading many sexually transmitted


Kayode Ojo
Kayode Emmanuel Ojo is the Co-Founder and Managing Director at SHEFFA Limited. He is presently studying Computer Science at the National Open University, Victoria Island, Lagos.