HIV Natural History

The natural history of HIV disease can be divided into a number of stages:
primary HIV infection
asymptomatic infection
symptomatic disease
advanced disease
 1. Primary infection
Occurs 2-6 weeks of exposure
Usually mild and non-specific
The best-known syndrome is a glandular fever-like illness with fever and
generalized lymphadenopathy.
Maybe misdiagnosed as malaria.
Clinical manifestations of primary HIV infection
glandular-fever like illness: fever, sore throat, generalized
lymphadenopathy
skin rash
weight loss
nausea, diarrhoea, abdominal pain, vomiting
oral and/or genital ulceration
headache, photophobia, meningism, peripheral neuropathy, facial
 Serocoversion
Conversion from HIV anti- body negative to antibody positive
Occurs after 2-12 weeks
the HIV viral load rises to a peak (check the diagram)
individuals are highly infectious at this time.
CD4 count typically drops transiently, and occasionally falls to very low
levels such that conditions typical of more advanced HIV disease, such
as oral candidiasis.
This will normally resolve as the CD4 count recovers.
 2. Asymptomatic infection
Onset of diseases characteristic of advanced immunosuppression is around 10
years (if not taking ART), but with wide variation between individuals.
The viral load is relatively stable after the high levels at seroconversion after 6-9
months, this is the set point.
Represents an equilibrium between viral replication and the attempts of the hosts
immune system to control replication.
The CD4 count falls progressively during the asymptomatic period, by an average
of 5075 cells/l per year.
Persistent generalised lymphadenopathy with nodes typically < 2 cm diameter is
a common finding.
 3. Symptomatic disease.
Most early symptoms of HIV infection are relatively non-specific, including
skin and mucous membrane disorders such as reactivation of varicella-zoster
virus
fungal skin and nail infections
prurigo (a generalized itchy maculopapular eruption which eventually heals,
often leaving pigmented macules)
There may also be constitutional symptoms such as unexplained fever and weight
loss.
Tuberculosis can occur at any stage of HIV disease and should always be
considered in individuals with fever, weight loss or cough

 4. Advanced disease
When the CD4 count falls below 200 cells/l, people with HIV also become
susceptible due to disease caused by organisms of relatively low pathogenicity
(so-called opportunistic infections), such as cerebral toxoplasmosis, cryptococcal
disease, cryptosporidiosis and Pneumocystis jiroveci pneumonia (PJP).
AIDS
AIDS is defined by the development of specified opportunistic infections, cancers
and severe manifestations of HIV itself