The time from HIV infection to the development of AIDS varies. Rarely, some individuals develop complications of HIV that define AIDS within one year, while others remain completely asymptomatic after as many as 20 years from the time of infection. However, in the absence of antiretroviral therapy, the time for progression from initial infection to AIDS is approximately eight to10 years. The reason why people experience clinical progression of HIV at different rates remains an area of active research.
Within weeks of infection, many people will develop the varied symptoms of primary or acute infection which typically have been described as a "mononucleosis" or "influenza" like illness but can range from minimal fever, aches, and pains to very severe symptoms. The most common symptoms of primary HIV infection are
- fever,
- aching muscles and joints,
- sore throat,
- and swollen glands (lymph nodes) in the neck.
It is not known, however, why only some HIV-infected people develop these symptoms. It also is unknown whether or not having the symptoms is related in any way to the future course of HIV disease. Regardless, infected people will become symptom-free (asymptomatic) after this phase of primary infection. During the first weeks of infection when a patient may have symptoms of primary HIV infection, antibody testing may still be negative (the so-called window period). If there is suspicion of early infection based upon the types of symptoms present and a potential recent exposure, consideration should be given to having a test performed that specifically looks for the virus circulating in the blood, such as a viral load test or the use of an assay that identifies HIV p24 antigen, for example, the new fourth-generation antibody/antigen combination test. Identifying and diagnosing individuals with primary infection is important to assure early access into care and to counsel them regarding the risk of transmitting to others. The latter is particularly important since patients with primary HIV infection have very high levels of virus throughout their body and are likely to be highly infectious. Once the patient enters the asymptomatic phase, infected individuals will know whether or not they are infected if a test for HIV antibodies is done.
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