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Acute HIV Infection

Why It's Important to Recognize Acute HIV Infection


Updated: November 26, 2009

In emergency departments and family practice offices across the country and around the world, a dangerous scenario takes place; acute HIV infections being missed. People are presenting to ERs with complaints of HIV symptoms such as fever, headache, muscle and joint aches, sore throat, rash and diarrhea. In response to these symptoms, physicians don't diagnose acute HIV infection. Instead they diagnose the flu or other benign viral illnesses and send the patient on their way. In the majority of cases, their diagnosis proves correct. Unfortunately, a number of people with these vague, indistinct symptoms have a much more serious illness than the flu. For some, these symptoms signal the acute stages of HIV infection or acute HIV infection.

What are the Symptoms of HIV?

What is Acute HIV Infection?

Acute HIV infection goes by several names; acute HIV syndrome, acute retroviral syndrome or primary HIV infection to name a few. In the mid and late 90s, acute HIV syndrome was initially described as a flu or mononucleosis-like illness affecting gay men. Since those early years of HIV, acute HIV syndrome can now be identified in 30 percent to 50 percent of all newly HIV infected people. In those days immediately after infection occurs, HIV replication is extremely rapid, resulting in a dramatic peak in the HIV viral load. In essence, HIV has caught the body's immune system off guard.

As the level of active HIV increases, a large number of CD4 cells are destroyed, resulting in a dramatic decrease in CD4 count and a weakening of the immune system. As the immune system weakens, symptoms of acute HIV syndrome may begin to appear. These symptoms can include fever, fatigue, headache, muscle and joint aches, sore throat, rash, weight loss and diarrhea. Of all the symptoms that may appear, fever is the most common. Because the symptoms are common in other viral illnesses such as influenza ("the flu") or mononucleosis, the diagnosis of acute HIV syndrome is often missed and the patient is sent home unaware that they have been recently infected with HIV. Typically, the symptoms of acute HIV syndrome occur five to 30 days after the initial infection and can last several weeks.

HIV Replication - Step by Step

Understanding CD4 and Viral Load

How is Acute HIV Syndrome Diagnosed?

Medical professionals must understand acute HIV syndrome and must consider HIV in anyone who presents with acute HIV signs and symptoms. The key is a complete sexual and HIV risk factor assessment for anyone who presents to their office or emergency room. For instance, if a 60-year-old grandmother presents with fever, weight loss, and swollen lymph nodes, it is a mistake to assume she is not at risk for acute HIV syndrome simply because she is not what some consider to be a "typical" HIV patient. Because HIV does not discriminate, she should have a sexual history assessment and an HIV risk assessment just like a gay white male would in the same situation. Making assumptions about who is at risk for HIV infection can mean a HIV diagnosis will be missed.

Taking a Detailed Sexual and HIV Risk Factor History

Behaviors that Increase the Risk of HIV Infection

Why Is Acute HIV Syndrome Recognition Important?

Identifying acute HIV early has benefits for the patient and his sexual partners, as well as helping scientists better understand the virus.
  • Early HIV testing and diagnosis provides the first opportunity to appropriately counsel patients with regard to HIV prevention. Being aware of an HIV infection protects their sexual partners from unknowingly being infected.

    Testing & Prevention Resources

    Safer Sex Resources

  • Early diagnosis means earlier medical care that has been shown to be a positive influence on the course of HIV throughout a person's lifetime. Getting into care earlier in the course of the disease translates into a better long-term prognosis and a longer, healthier life.

    HIV Diagnosis - Day #1

  • Early diagnosis of HIV can have a public health benefit as well. Getting patients into care, counseled on how HIV is spread from person to person, and teaching ways to prevent infecting others helps control the spread of HIV. In addition, identifying acute HIV educates our scientists on how HIV infection occurs and presents, which in turn can help them develop new prevention education, new treatment, and eventually could help vaccine development.

  • Recognizing acute HIV syndrome may creates a brief opportunity to control the initial immune system damage from HIV. The early spread of the virus greatly affects the course of the disease and sets immune system damage into motion. Experts believe that early intervention with antiretroviral medications during that acute HIV period may limit the initial immune system damage at the hands of HIV. However, the benefit of treatment during the acute stage of HIV is controversial.

    How is HIV and AIDS Treated?

Some estimates show that a quarter to a third of all HIV infected persons are unaware of their infection. It's not hard to see what a huge impact this fact can have on HIV transmission and the health of those infected. All one has to do is look to Africa to see the potential effects of being unaware. The medical community has to make a concerted effort to train its members how to recognize acute HIV syndrome and what to do once it is diagnosed. Emergency Rooms across the country must turn their back on conventional thinking and allow for acute HIV testing via their departments. Family practice and primary care physicians must build referral resources that provide HIV testing and counseling that includes attention to acute retroviral syndrome. We have the ability to fight HIV, we just have to know it's there.

HIV Around the World - Next Stop South Africa


Altfeld, M., "Acute HIV-1 Infection"; HIV Medicine; 2006.

Rosenberg, E., "Primary HIV Infection and the Acute Retroviral Syndrome: The Urgent Need for Recognition"; AIDS Clinical Care, 1 Mar 1997.

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