A Note About Acute HIV Infection

Acute HIV Infection is a very important, yet little known and heard about, part of HIV and the tragedy of HIV transmission.

Acute Infection describes the stage of HIV which usually occurs between 2-4 weeks after the contraction event, although it sometimes may take longer. During this stage, the body has yet to recognize and start fighting the virus, therefore allowing the virus to rapidly increase and attack the body. The result is certain flu like symptoms, including headache, fever, loss of appetite, rash, diarrhea, vomiting, etc. However, in most cases, just as symptoms begin to appear, the body finally recognizes the virus, develops antibodies against it, and naturally starts fighting it. Therefore, most people who experience symptoms of Acute HIV Infection think they have the flu. They might feel down for a few days, and then the symptoms resolve on their own, and the person moves on with their life--- never knowing or finding out that they have just contracted HIV. Furthermore, many doctors are not trained or prepared to recognize symptoms of Acute Infection, or they simply mistakenly believe that the patient just has the “flu”, without ever considering doing an HIV test. Finally, if a rapid HIV test is for some reason done during this period, it may come back Negative, as the test is testing for antibodies which the body has not yet produced! Long story short, it is very uncommon for HIV to be found and diagnosed during the Acute Infection phase.

Now, what makes this worse is the effect of this phenomenon on transmission. You see, when a person is in the Acute phase or newly contracted, their body has not had a chance to fight the disease, and their viral load is likely to be very high. The higher a persons’ viral load, the more infectious they are, and the easier it is for them to transmit the virus to others. So, pair a high viral load with a person that has no idea that they’ve contracted the virus, and you have a very dangerous thing. Reports estimate that as many as 50% of HIV transmissions occur during the acute and early stage of the illness.

Now, to connect this with my story- I went through an extremely severe case of Acute HIV Infection. I experienced almost every symptom on the list, but to a higher degree than most. My symptoms began exactly 17 days after contraction, which falls in that average 2-4 week period. My first two HIV tests came back Negative also, because my body had not yet developed the antibodies. In addition to these typical symptoms, my platelet levels were extremely low, and my liver functioning was extremely high (this means bad). This is why I was hospitalized and this is why they found it. My first results showed my CD4 (immune system) was very low, and my viral load was over 10 million (the maximum measurement range). Although it was a horrible experience to be so severely ill, it is a good thing that I was, otherwise we may have never found it, and I could still be in Zambia, and possibly passing it along to others.

Another part of the puzzle…

I had asked the guy before being with him if he had been tested for HIV. He said he had been tested earlier in the year and it was Negative. He neglected to mention, and I neglected to find out, that he had slept with someone after that Negative test (which therefore really makes me asking him at all pointless and void).

I further questioned him about this while I was in South Africa (after being diagnosed), and I also explained the Acute Infection to him. And it all of the sudden clicked and he said, “Oh my gosh. I did get sick with the flu or Malaria a couple weeks after being with that girl”. I said, “BINGO”, and we knew that that had been it.

So, we are a perfect example. He had been recently infected, may have experienced symptoms, but mistook them for Malaria, and never suspected HIV. His viral load was most likely still very high when he met and passed it on to me. The doctors agree that this is most likely the case, as they feel that his viral load must have been extremely high to infect me through the low risk activities that we participated in.

In an e-mail from October, I wrote to a Peace Corps HIV Educator… “One last thing that I think you could talk about more is Acute HIV Infection- including the timing (1-4 wks after infection), and the common symptoms. This is something I feel like I never knew about. I didn't know before that people commonly fall sick with flu like symptoms about 2 weeks after infection. And most people don't know this, and they ignore it, thinking they have the flu, and then they don't ever consider or find the HIV. We are told to look at sexual partners and consider whether they "seem sick" or if they have any sores or cuts on their genitalia. But, I think a better suggestion would be to ask our partners if they have had any flu or malaria-like illnesses recently (or if you want to get real specific- shortly after being with their last partner). If I had known this information and asked my partner about it, he would have told me that yes, actually he did have malaria like symptoms a couple weeks after being with his previous girl (5 months ago). And I could have known to be suspicious right there with that information.”

I am not saying that everyone should freak out if they get the flu, however I do think that this part of HIV needs to be talked about more, so that people are familiar with the pattern of the disease progression, and may be more likely to recognize the symptoms. As always, thanks for listening!

P.S. I will continue the Medevac story tomorrow...