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Understanding the 3 Stages of HIV

What Are the HIV Stages?

Human immunodeficiency virus (HIV), if left untreated, eventually leads to a life-threatening condition called Acquired Immunodeficiency Syndrome (AIDS). AIDS is the third and final stage of HIV.

People living with HIV cannot be recognized by appearance alone and many are often unaware that they may be transmitting the virus. This is why testing is so important, because symptoms are often unnoticeable until it's too late. Early diagnosis and treatment adherence are crucial in reducing HIV transmission. Dealing with this disease means understanding how the virus works and then looking beyond it.

HIV Transmission

HIV is primarily acquired and transmitted by sexual intercourse (vaginal, anal and sometimes oral), exposure to infected blood (needle sharing in injection drug use, transfusion of contaminated blood) and mother to fetus transmission. Exposure to blood or blood products carry the maximum risk of infection.

Body fluids that transmit HIV:

  • Semen
  • Vaginal and rectal secretion
  • Blood (including menstrual blood)
  • Breast milk
  • Pre-cum

Body fluids that cannot transmit HIV:

  • Saliva
  • Urine
  • Tears
  • Sweat

Sexual contact between a man and a woman, two men and two women is the most common means of spreading HIV. The risk of acquiring the virus is 22 times higher in men who have sex with men, most frequently due to unprotected anal intercourse. The receptive partner is at a higher risk than the inserting partner. Female to female transmission is uncommon but can occur.
How HIV Invades Cells

HIV needs to invade cells to reproduce copies of itself and establish an infection. A virus has either ribonucleic or deoxyribonucleic acid (RNA or DNA) as its genetic material, which specifies its biological development. HIV has RNA. With the help of an enzyme called reverse transcriptase, it produces more viruses by converting viral RNA into DNA.

The viral DNA is then integrated into the genetic coding of certain human immune cells vital for the body’s defense against diseases. Once the HIV DNA invades the infected cell’s genes, it cannot be eliminated without destroying the cell itself.

After invading immune cells, HIV virions are released from the infected cells and enter the bloodstream, in which they are carried to the different sites within the body. The lymph nodes, liver, spleen, bone marrow and the gastrointestinal mucus layer provide a substantial reservoir for HIV.

The 3 Stages of HIV Infection

The pattern of HIV infection does not follow those of traditional viral diseases. We know that the longer the individual is infected, the more likely the development of serious illnesses and subsequent death will be. The speed at which HIV evolves into AIDS may vary and people who are taking HIV medications may not progress to AIDS for many years.

Stage 1: Acute Primary Infection

Primary infection, also known as acute seroconversion syndrome, occurs within two to four weeks after transmission. It is accompanied by rapid viral replication with a decline in CD4 T cell count. Testing will reveal high levels of HIV in the blood. The risk of transmission is also increased. Starting antiretroviral treatment (ART) is recommended during this stage.

Common symptoms include:

  • Fever
  • Sore throat
  • Lymphadenopathy (swollen lymph nodes or glands)
  • Rash
  • Diarrhea
  • Headache

Stage 2: Chronic Infection

After the primary infection stage, patients may start to feel better. This period can last for about 10 years or longer and may not cause any other symptoms. However, the person still harbors the virus as it continually infects new cells and makes copies of itself. HIV can still be transmitted during this stage. According to a study, without ART, CD4 cell count declines about 4% per year.

Stage 3: Acquired Immunodeficiency Syndrome (AIDS)

AIDS is not a separate disease entity but the final stage of HIV. Without therapy, AIDS patients typically survive for about three years. An HIV-positive individual is said to have progressed to AIDS when:

  • They have a CD4 count of less than 200 cells/mm3
  • They develop certain opportunistic infections

Opportunistic infections are infections that take advantage of a host’s weakened immune system. They occur more often or more severe in people with HIV. In the U.S., the most common opportunistic infections in people with HIV include herpes simplex virus (HSV) infection, salmonellosis, thrush (candidiasis), pneumonia and toxoplasmosis.

Antiretroviral Treatment

Early recognition leads to better treatment outcomes. Recent data from UNAIDS, the Joint United Nations Program on HIV and AIDS, showed that there were 37.9 million people living with HIV in 2018. Among those who were accessing treatment, 86% were virally suppressed. Antiretroviral treatment reduces the risk of HIV transmission by more than 95%.

Regardless of viral load and CD4 count, all people living with HIV are advised to follow an HIV regimen by taking combination antiretroviral medications. The Department of Health and Human Services (HHS) guidelines on the use of HIV medicines in adults and adolescents recommend an initial HIV regimen that includes three antiretroviral drugs from at least two different HIV drug classes. Talk with your healthcare provider to know which HIV medication is right for you.
Methods of Prevention

HIV is a preventable disease. Although a total cure is still nowhere to be found, with treatment adherence, the majority of HIV patients live nearly as long as those who do not have HIV. According to UNAIDS, new HIV infections have declined by 40% since its peak in 1997. About 1.7 million were newly infected with HIV in 2018, compared to 2.9 million in 1997.

HIV Testing

Awareness is key. HIV testing is a critical tool in both prevention and treatment. Knowing your status allows you to change behaviors, such as engaging in unprotected sex or breastfeeding, that put you and others at risk. Standard tests may start with a pretest interview with a trained counselor. Some facilities and community agencies offer confidential or “anonymous” testing. These tests are usually free of charge. Home testing kits are available without a prescription from local drugstores.

Practice Safe Behavior

Using a condom every time you have vaginal or anal sex is an effective way of preventing HIV transmission. Those who inject drugs should avoid sharing needles, syringes and any drug equipment with others.
Medications That Prevent HIV

People who are at high risk of being infected with HIV can take prophylaxis drugs to protect them from the virus. Pre-exposure prophylaxis (PrEP) should be taken prior to sexual intercourse while Post-exposure prophylaxis (PEP) must be started within 72 hours after exposure to HIV. Talk to your healthcare provider about PrEP and PEP.

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