What Is Acute Hiv Infection

Is It Safe For Children With Hiv To Receive Routine Immunizations

• MMR, or measles, mumps, and rubella vaccine, is safe to give to children with HIV, unless they have a severely weakened immune system.

• DTaP/Td vaccine is safe to give to infants and children with HIV.

• Hib and Hep B vaccines are safe to give to children with HIV.

• Hepatitis A and B vaccines are safe to give to HIV-positive children.

• VZIG should be considered for known HIV-positive children, depending on their immune status.

• A yearly influenza vaccine is recommended for children with HIV, as well as any individual living in the same household as a child with HIV. There are two types of influenza vaccine children and adults with HIV should receive the shot form of the vaccinenot the nasal spray form, as it contains a live virus. Pneumococcal vaccine can be safely administered to age-appropriate HIV-infected children.

Always consult with your childs doctor regarding immunizations for an HIV-infected child.

How Does Acute Hiv Infection Usually Manifest

Acute HIV infection, typically occurring within weeks of an exposure to HIV-infected bodily fluids, represents the time in which a patient has high levels of plasma HIV RNA and an emerging humoral immune response with the development of detectable viral protein-specific antibodies. This period is frequently associated with an acute illness referred to as an acute retroviral syndrome . This stage of HIV disease is also referred to as primary HIV infection. Often described as an influenza- or mononucleosis- like illness, the signs and symptoms are nonspecific and occur with variable frequency and severity. Symptoms can be minimal, very mild, or severe. Up-to-date screening tests are able to identify those with evidence of viremia in the absence of antibodies, regardless of presence of symptoms. For those presenting with symptoms, the more commonly described manifestations include:

Figure 1.

The natural history of HIV infection

Viral Diversity And Infectivity In Early Hiv Infection

Viral isolates can be recovered from patients with AHI, and high-resolution sequencing can be performed on virion-derived HIV RNA in plasma or tissue culture isolates. Studies of viral diversity during acute infection with clade B , clade C , or clade A HIV have been undertaken using single-genome amplification techniques, allowing greater resolution of the transmitted or acquired virus than heretofore possible. In the majority of cases a single HIV variant is transmitted after heterosexual transmission of HIV, and only rarely are > 23 variants transmitted. In the first weeks after infection, viral diversification and recombination are inevitable. Accordingly, detection of a single HIV variant generally confirms early infection. Differences between acute or early HIV and chronic HIV can be seen by the significant differences in the Hamming distance, which calculates the degree of diversity. Obviously, this approach is limited to very special research situations.

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Recommended Testing To Diagnosis Acute Hiv

Detection of Acute HIV with Routine Screening for HIV

The HIV testing algorithm recommended by the CDC and APHL, which utilizes a laboratory-based HIV-1/2 antigen-antibody immunoassay as the initial screening test, will detect approximately 80 to 85% of persons with acute HIV infection. With this algorithm, persons with acute HIV would typically have a positive initial screening test with the HIV-1/2 antigen-antibody immunoassay, followed by a negative HIV-1/HIV-2 antibody differentiation immunoassay, and then a positive HIV-1 RNA test . The ability of this routine screening algorithm to detect most persons with acute HIV is one of the primary reasons the CDC now advocates using this HIV testing approach for routine screening. In the situation where the routine screening testing algorithm detects HIV, follow-up antibody testing in 3 to 6 months should be performed to document seroconversion. From a practical standpoint, routine screening for HIV infection using HIV NAT is not practical due to cost considerations.

Testing for Suspected Very Early Acute HIV Infection

What Is Acute Human Immunodeficiency Virus Infectionsyndrome

Acute human immunodeficiency virus infection syndrome refers to symptoms experienced by many people at the time of initial infection with human immunodeficiency virus . It is also known as acute retroviral syndrome.

The syndrome consists of nonspecific symptoms including fever and rash. It resolves gradually as seroconversion occurs.1,2

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Hiv Treatment As Prevention

Treatment as prevention refers to taking HIV medication to prevent the sexual transmission of HIV. It is one of the highly effective options for preventing HIV transmission. People living with HIV who take HIV medication daily as prescribed and get and keep an undetectable viral load have effectively no risk of sexually transmitting HIV to their HIV-negative partners.

TasP works when a person living with HIV takes HIV medication exactly as prescribed and has regular follow-up care, including regular viral load tests to ensure their viral load stays undetectable.

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Signs And Symptoms Of Hiv/aids

The stages of HIV infection are acute infection , latency and AIDS. Acute infection lasts for several weeks and may include symptoms such as fever, swollen lymph nodes, inflammation of the throat, rash, muscle pain, malaise, and mouth and esophageal sores. The latency stage involves few or no symptoms and can last anywhere from two weeks to twenty years or more, depending on the individual. AIDS, the final stage of HIV infection, is defined by low CD4+ T cell counts , various opportunistic infections, cancers and other conditions.

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Testing For Recent Hiv Infection

For individuals with a positive HIV antibody test and suspected recent infection, it is important to try and determine the last negative HIV test. In this setting, a negative HIV-1/2 antigen-antibody immunoassay in the prior 6 months would support a diagnosis of recent HIV infection. From a research standpoint, the detuned HIV antibody assay could confirm recent infection, but this test is not widely available in clinical settings.

Establishment Of Hiv Infection

The dendritic cells that are infected with HIV can migrate to lymph nodes, where they interact with and potentially fuse with CD4 cells, causing spread of HIV to deeper tissues. Within a few days of inoculation, HIV is present within gut-associated lymphoid tissue and other tissues of the lymphoreticular system, causing irreversible depletion of helper T cells and establishment of viral latency . Although HIV generally exists as a quasispecies or a mixture of mutant strains, usually only one strain successfully establishes initial infection the infecting strain is known as the founder virus. Data indicate that selection bias leads to transmission of virus species with greater relative fitness. Investigators have shown that humans typically develop HIV viremia within 11 days of initial transmission.

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Antiretroviral Treatment Of Acute Hiv Infection

To quote from the current Treatment Recommendations as published by the NIH in 2016:

• Antiretroviral therapy is recommended for all HIV-infected individuals, regardless of CD4 T lymphocyte cell count, to reduce the morbidity and mortality associated with HIV infection .

• ART is also recommended for HIV-infected individuals to prevent HIV transmission .

• When initiating ART, it is important to educate patients regarding the benefits and considerations regarding ART, and to address strategies to optimize adherence. On a case-by-case basis, ART may be deferred because of clinical and/or psychosocial factors, but therapy should be initiated as soon as possible.

These recommendations also apply to patients with acute HIV infection. Prevention of transmission is a important concern such patients are particularly infective because of their high viral load.

The rationale for considering early treatment includes:

• Shorten the duration and/or severity of symptoms

• Reduce risk for more rapid disease progression

• Reduce the risk of transmission to others Preserve immune reserve and gastrointestinal integrity

• Preserve HIV-specific immune responses, which might allow for enhanced viral control if treatment is stopped or to be stimulated by therapeutic immunogens that might become available in the future

• Limit size of the viral reservoir

Who Is At Risk Of Acute Hiv Infection

HIV can affect people of any age, sexual orientation or race, in any part of the world. However, certain groups of people are more at risk of contracting HIV than others. These can include people who:

• Have unprotected sex, particularly anal sex, with multiple partners
• when injecting substances

HIV can be spread in the following ways:

• Contact with infected blood
• Contact with infected vaginal and/or rectal fluids
• From mother to child during pregnancy or birth if the pregnant woman has HIV
• Less commonly, during breastfeeding if the breastfeeding woman has HIV and is not on antiretroviral treatment
• Sharing needles, syringes or drug preparation equipment with someone who has HIV

Other physical contact, such as hand-holding, kissing or hugging, does not transfer HIV..

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Preservation Of Immune Function And Delayed Disease Progression

Early antiretroviral therapy can help preserve immune function and slow HIV disease progression by slowing CD4 decline and reducing HIV RNA levels. One study analyzed differences between a group of individuals who started antiretroviral therapy within 2 weeks of seroconversion , a group who started between 2 weeks and 6 months of seroconversion , and a group who declined to initiate therapy individuals in the acute and early treatment arms took therapy for at least 3 months then stopped. At 6 months after treatment interruption, groups who initiated treatment had lower HIV RNA levels and higher CD4 counts, with the greatest benefit seen in those who initiated within 2 weeks of seroconversion. Multiple studies, including the Setpoint Study , Primo SHM, and SPARTAC, have demonstrated a reduction in viral set point and slower disease progression after initiation of antiretroviral therapy during early HIV infection.

How Can I Keep From Getting Hiv

The best way to protect yourself is to avoid activities that put you at risk. Theres no way to tell by looking at someone if he or she has HIV. Always protect yourself. Use latex condoms whenever you have any type of sex .

• Dont use condoms made from animal products.
• Use water-based lubricants .
• Never share needles to take drugs.
• Avoid getting drunk or high. Intoxicated people might be less likely to protect themselves.
• Consider getting testedit is really important to be aware of your HIV status.

If you are a healthcare worker, you are at a slightly higher risk of getting HIV from a needle-stick injury, skin contact with contaminated fluid or from human bites. You should follow universal precautions:

• Always wear protective equipment when dealing with blood and body fluids.
• Follow careful hand-washing guidelines when dealing with such fluids.
• Follow safe handling guidelines for needles and sharp instruments.
• Be aware of post-exposure policies at your workplace.

If you are in a relationship with a partner who has HIV, or you are at high risk for any other reason, consider using pre-exposure prophylaxis, commonly called PrEP. This means taking one of two medicines every day, emtricitabine-tenofovir or emtricitabine-tenofovir alafen .

If you are a person with HIV who is in a relationship with a person who is HIV-negative, you should also be on a medication regimen.

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Reduced Risk For Hiv Transmission

In the acute phase, newly infected persons have a significant increase in risk of transmitting HIV to others due to several factors: they have initial uncontrolled viremia with associated high levels of HIV in the genital tract, their initial HIV quasispecies is less varied and probably better adapted for transmission than later in the course of HIV infection, and they are often unaware of their HIV status. For the year 2016, the CDC estimated that among the 38,700 new HIV infections in the United States, 1,500 involved transmissions from persons with acute HIV. The Duke-UNC-Emory Acute HIV Consortium examined viral dynamics at different phases of HIV disease and found markedly higher semen and blood HIV RNA levels in men during acute HIV infection than in men with chronic HIV, thus providing a biologic basis for the reported increases in HIV transmission during early HIV infection. This same group also generated models for calculating probabilities of male-to-female HIV transmission per coital act that projected a markedly higher risk of HIV transmission during acute HIV infection than in the subsequent months after acute infection . In addition, other groups of investigators have shown that for every 10-fold increase in viral load, the risk of transmission increases by a factor of 2.5, so a prompt reduction in the very high HIV RNA levels with acute or early HIV infection could be a key in preventing HIV transmission.

Who Is At Risk Of Aids

HIV is mainly spread through anal or vaginal sex, or sharing syringes or other equipment that involves injections. With that said, according to HIV.gov, there are certain risk factors associated with contracting HIV, these include:

• Having unprotected sex
• Certain health problems or sexually transmitted infections
• Blood transfusions

Its important to remember that many people with HIV infection may experience little to no symptoms making it easy for the virus to go unnoticed and undiagnosed. Early detection of HIV and the correct HIV treatment and medication is key to going on to live a healthy life, which is why regular screening of your sexual health is crucial. Testing can be done with your local healthcare provider or from home with an at-home lab test.

LetsGetCheckeds at-home STI Tests detect some of the most common sexually transmitted infections. The blood test for HIV involves a simple finger-prick sample and online results will be available within 2-5 days. Our dedicated medical team will be available throughout the process to provide medical advice, support, and guidance.

You consider taking a test if:

• You should also consider getting tested if:
• You become sexually active
• You have had unprotected sex
• You are experiencing symptoms of a sexually transmitted infection
• You are entering into a new sexual relationship
• You have received a notification from a previous partner that they are infected

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Prevention Of Acute Hiv Infection

There are ways to minimize the risk of contracting HIV, or passing the infection on to other people:

• Practice safe sex: use condoms during all types of sexual contact and limit the number of partners
• Practice safe needle use: use only sterile needles and equipment if injecting substances. Safe needle use should also be observed by healthcare workers and tattooists
• Get diagnosed early, which can inform choices such as treatment and behavior toward other people

Anyone who is sexually active is recommended to get tested for HIV and other sexually transmitted diseases at least once a year. Any positive results should be disclosed to sexual partners so precautions can be taken. More frequent testing is recommended for anyone in a high risk group, such as someone who:

• Is in a relationship with a person who is HIV-positive
• Has multiple sexual partners

Rationale For Initiating Antiretroviral Therapy During Acute Hiv Infection

There are several reasons given for considering the early initiation of antiretroviral therapy during acute HIV infection. Some might also apply to those with documented early infection .

To shorten the duration and/or severity of symptoms

Anecdotal evidence indicates that symptoms of the acute retroviral syndrome abate rapidly after starting antiretroviral therapy. However, no controlled studies are available.

To reduce the risk for more rapid disease progression

The data is extremely variable, but there are increasing numbers of retrospective, observational studies that demonstrate a relationship between the number and severity of symptoms associated with acute HIV infection and a variety of measures of disease progression.

If true, it is not clear that starting treatment within days or weeks of acute infection will influence outcome, but it does suggest that patients with symptomatic acute HIV infection are more likely to progress to the point of needing antiretroviral therapy sooner than those with less symptomatic acute infection.

To reduce the risk of transmission to others

Molecular studies demonstrate that people with acute infection may be disproportionately contributing to new cases of infection within a given community. In fact, several studies report up to 30% of incident HIV infections may be from those with acute HIV infection.

To preserve immune reserve and gastrointestinal integrity

The three recent studies include:

To limit size of the viral reservoir

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How Is Hiv Diagnosed

An HIV antibody test, either from a blood sample or an oral sample , can tell whether you have been infected. A negative test result means no HIV antibodies were found. This usually means you are not infected. However, if you engaged in behavior that could spread the virus within three months of having the test, antibodies may not be detectable and you should be re-tested. A positive test result means antibodies to HIV were found. This means you are infected with the virus and can pass HIV to others even if you have no symptoms. You are infected for life. Even if you think you have a low risk for HIV infection, consider getting tested whenever you have a regular medical check-up.

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Learning Objective Performance Indicators

• Explain the immunopathogenesis, clinical manifestations, and diagnosis of acute HIV infection
• List the potential public health benefits of diagnosing and treating a person with acute and recent HIV infection
• Summarize the recommended antiretroviral treatment regimens for persons with acute or recent HIV infection

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Risk Of Immune Damage

Some people think that there?s not much harm done in the early stages of HIV infection. They believe that any damage to their immune system will be cured by taking antiretroviral therapy . This is not true!

Up to 60% of infection-fighting ?memory? CD4 cells are infected during acute infection, and after 14 days of infection, up to half of all memory CD4 cells can be killed. Also, HIV quickly reduces the ability of the thymus gland to replace lost CD4 cells. The lining of the intestine is also damaged very quickly. This can all occur before a person tests positive for HIV.