Primary HIV Infection

The earliest stage of HIV infection is called primary HIV infection, but it may also be called: acute HIV infection; HIV "seroconversion" illlness; acute retroviral illness; or just new HIV infection.  “Sero” means blood and “conversion” means changing as the blood changes over from HIV negative to HIV positive. HIV is a retrovirus--more about that later.

The person with primary HIV infection will usually feel sick 1-4 weeks after getting infected.  In most cases, the person may feel ill, but won't relate their feeling bad to their recent risky behavior.   

Primary HIV infection is the earliest stage of the infection, from the time the virus first enters the body to the time the body makes antibodies to fight against HIV.  

What are the symptoms of primary HIV infection?

During the time immediately after HIV-infected blood enters the body--either through the blood, the vagina, the rectum, or the mouth--until the body develops antibodies, the person may feel ill.  Somewhere around 50-90% of newly-infected people will experience a sudden illness.  At this time, high levels of virus (more than 100,000 copies or particles) are running rampant through the bloodstream, but the body has not yet had enough time to mount a defense against this new invader. 

Here are the symptoms of primary HIV infection:

Fever; red raised rash; fatigue (tiredness); sore throat; swollen glands; itching; painful muscles or joints; sores in the mouth; headache; pain behind the eyes; meningitis (inflammation of the covering of the brain); myelitis (inflammation of nerves); loss of appetite

These symptoms may be so slight as to almost go unnoticed or may make the person feel quite ill.  Unfortunately, if the person does go to a medical provider, they will probably be misdiagnosed--perhaps told they have the flu, or mononucleosis, or some other viral infection.  That’s because primary HIV infection symptoms are the same as these other common illnesses.

In some cases, the medical provider will suspect primary HIV infection.  One important thing to remember is that the HIV ELISA antibody test will be negative until an average of around 25 days after getting infected.  So even if a HIV ELISA test is done, it may come back as negative.  Sometimes the HIV ELISA test results will be "indeterminate".  This just means not negative and not positive.  The HIV test will need to be repeated in a few weeks.  

The test to find out if someone has primary HIV infection is the HIV viral load test (or HIV-1  RNA).  This test measures the actual amount of HIV virus in your blood.  Unlike the ELISA HIV antibody test, which measures HIV antibodies in the blood, this test is measuring the actual virus particles in the blood. 

If someone has just gotten infected with HIV, the HIV viral load will be very high, or more than 100,000 particles (copies) in 1/5 teaspoon of blood.   During primary HIV infection, if the HIV viral load is less than 100,000, that person is not considered to be HIV positive. 

Consider the following example:

Bob goes to an urgent care center with around 2 days of a sore throat,  fever, and muscle aches.  Marie,  the physician assistant on duty, thinks Bob has the flu, which is going around right now.  She asks Bob about any recent unprotected sex with a new partner.  At first, Bob is annoyed by what he thinks is a stupid question, but then Marie tells Bob why she wants to know the answer.  Bob calms down and says that about two weeks ago, he went to a bar and went home with another man.  They had sex just that one time and the man refused to wear a condom.  Marie is worried that Bob may have a new HIV infection and asks Bob for permission to run an HIV test.  Bob’s HIV ELISA test is negative. Marie is really worried about Bob, so she sends his blood for an HIV viral load test.  The next day, Bob’s HIV viral load results show 250,000 particles (copies) of HIV.  Marie calls Bob and asks him to come to the clinic because she must talk to him in person.  What’s the bad news?  Bob has primary HIV infection.  Is there any good news here?  Yes, actually there is.  Catching HIV in the earliest stages is much better than going for years not knowing you have the infection.  Early diagnosis means that Bob will have a chance to treat his HIV before he gets sick.
 

Since most people don't know when they have primary HIV infection, these people find out they have HIV quite accidently, perhaps 10 to 20 years after infection, when they develop an illness that points to the diagnosis.  This illness is called an opportunistic infection, abbreviated OI.  That's why all sexually active people (or those who inject street drugs) should get an HIV test once a year.