The clinical manifestation of HIV infection have a spectrum ranging from an acute syndrome associated with primary infection to a prolonged asymptomatic state to advanced disease. In most of the patients active virus replication and progressive immunologic impairment occur throughout the course of HIV infection.
Approximately 50–70% of individuals with HIV infection experience an acute clinical syndrome in about 3–6 weeks after primary infection. This is Acute HIV Syndrome. Clinical manifestations vary from individual to individual to a great extent. It is suggested that symptomatic seroconversion leading to the seeking of medical attention indicates an increased risk for an accelerated course of disease. There is no correlation between the level of the initial burst of viremia in acute HIV infection and the subsequent course of disease.
The clinical manifestations (general) are fever (long duration of more than one month), diarrhea (long duration of more than one month), weight loss (more than 10%). Pharyngitis, anorexia, nausea, vomiting are also some of the clinical manifestations. Lethargy, malaise, arthralgias (joint pain), myalgias (muscle pain), headache, retroorbital pain (pain behind the eyes), lymphadinopathy are also not uncommon symptoms. There are also neurological symptoms like meningitis, peripheral neuropathy (pathology of peripheral nerves), myelopathy (pathology of covering of nerves) and encephalitis. Skin manifestations like cutaneous ulceration of skin, maculopapular rashes are seen. All the above manifestations occur along with the burst of viremia.
It has been reported that many of the symptoms of the acute HIV syndrome (fever, pharyngitis, skin rash, and myalgia) occur less frequently in those infected by injection drug use than those infected by sexual contact. The manifestations are typical of an acute viral infection. Symptoms typically persist for one week to several weeks and gradually subside as immune response to HIV develops and the levels of plasma viremia decrease. Opportunistic infections have been reported during this stage of infection, due to immunodeficiency that results from reduced numbers of CD4+ T cells and also from the dysfunction of CD4+ T cells. The number of total lymphocytes and T cell subsets (CD4+T and CD8+T) are initially reduced and inversion of the CD4+/CD8+ T cells take place during Acute HIV Syndrome due to increase of CD8+T cells.
Lymphadenopathy occurs in approximately 70% of individuals with primary HIV infection. Most of the patients recover spontaneously from this and many are left with only a mildly depressed CD4+ T cell count that remains stable for a variable period of time before beginning its progressive decline.
Approximately 10% of patients manifest a fulminant (severe) course of immunologic and clinical deterioration after primary infection, even after the disappearance of initial symptoms. But in most of the patients, primary infection with or without the acute syndrome is followed by a prolonged period of clinical latency. A small percentage of HIV infected individuals treated with ARV drugs during acute infection may revert to a negative EIA test as long as they remain on therapy. But reseroconversion takes place very rapidly when ARV is withdrawn.
