Time Between Initial HIV Infection and AIDS is Not Symptom-Free

If left untreated, HIV infection inevitably degrades the immune system, leading to the development of life-threatening infections -- AIDS -- about 10 years later. The time between initial HIV infection and the development of AIDS is commonly referred to as the symptom-free, or asymptomatic, period. The reason for this is that during that time life-threatening infections are uncommon. The idea of dividing the stages of HIV disease into these specific periods occurred early in the course of the AIDS pandemic, when the medical focus was on delaying the appearance of severe infections and the always-looming spectre of death.

In 1996, highly active antiretroviral therapy (HAART) became available in high-income countries. As a result, for the first time in the history of AIDS, HIV positive people were able to recover from and resist life-threatening infections. Today, the benefits of HAART are clearly prolonged and so immense that researchers increasingly expect that some HIV positive people may live near-normal life spans.

Symptoms at All Stages

As mentioned earlier, the period between initial HIV infection and AIDS is referred to as the symptom-free, or asymptomatic, period. However, this idea may be changing. Researchers in Norway, South Africa, Taiwan, Kenya and the United States have been surveying HIV positive people about their health status. Their findings suggest that during the so-called asymptomatic period, HIV positive people may have symptoms after all.

Study Details

In total, 1,992 HIV positive people were surveyed. Their average profile was as follows:

• 35% female, 65% male
• age - 42 years
• 55% had been diagnosed with AIDS
• 70% were taking anti-HIV medicines
• 60% had serious co-existing health conditions

The study team divided participants into three groups based on their CD4+ cell counts, as follows:

• 0 to 200 cells
• 201 to 350 cells
• 351 or more cells

The survey asked questions about participants' health status, particularly about a wide range of symptoms covering physical and mental issues.

Results

In general, after assessing the number of symptoms reported, there were no significant differences among the three groups of people. This suggests that even at modest or high CD4+ counts, HIV positive people experience symptoms of illness.

Participants who were taking anti-HIV drugs tended to report less-intense symptoms than people who were not taking HAART.

Symptoms

Commonly reported symptoms included the following:

• fatigue
• depression
• muscle aches
• worry
• difficulty concentrating
• memory loss

For some participants, regardless of CD4+ counts, these symptoms were intense.

Some of the above-listed symptoms could occur as isolated problems or as part of many other health conditions, including but not limited to anxiety, depression and hormonal deficiencies. Although none of the study participants were experiencing life-threatening conditions, even those who had more than 350 CD4+ cells were experiencing symptoms of illness, perhaps unrelated to HIV.

The international study team suggests that doctors and nurses carefully interview their patients about health-related issues regardless of CD4+ counts. In doing so, health care professionals may uncover underlying conditions that are reducing their patients' quality of life, which would allow them to provide relief.

References

1. Letvin NL, Eaton KA, Aldrich WR, et al. Acquired immunodeficiency syndrome in a colony of macaque monkeys. Proceedings of the National Academy of Sciences USA. 1983. May;80(9):2718-22.
2. Roberts RB, Murray HW, Rubin BY, Masur H. Opportunistic infections and impaired cell-mediated immune responses in patients with the acquired immune deficiency syndrome. Transactions of the American Clinical and Climatological Association. 1984;95:40-51.
3. Sabin CA, Phillips AN. Should HIV therapy be started at a CD4 cell count above 350 cells/microl in asymptomatic HIV-1-infected patients? Current Opinion in Infectious Diseases. 2009 Apr;22(2):191-7.
4. Willard S, Holzemer WL, Wantland DJ, et al. Does "asymptomatic" mean without symptoms for those living with HIV infection? AIDS Care. 2009 Mar;21(3):322-8.