HIV: Patient Information and Testing Services
What is HIV?
HIV, or Human Immunodeficiency Virus, is a virus that attacks the body’s immune system, specifically targeting CD4 cells (T cells), which help the immune system fight off infections. If left untreated, HIV can lead to AIDS (Acquired Immunodeficiency Syndrome), a condition where the immune system is severely weakened, making the body vulnerable to opportunistic infections and certain cancers. Despite being a serious condition, advancements in medical treatments have made it manageable, allowing people with HIV to live long, healthy lives.
- Blood
- Semen
- Vaginal fluids
- Rectal fluids
- Breast milk
- Unprotected sexual contact: Engaging in vaginal or anal sex without using condoms or other barrier methods.
- Sharing needles or syringes: This is common among people who inject drugs.
- Mother to child: An HIV-positive mother can transmit the virus to her child during childbirth or breastfeeding.
- Blood transfusions: Although rare in countries with rigorous blood screening, transmission can occur through infected blood products.
In the early stages of HIV infection, many individuals may experience no symptoms at all, making the virus difficult to detect without testing. When symptoms do occur, they typically develop 2 to 4 weeks after exposure during what is known as the acute or primary HIV infection phase. This phase reflects the body’s initial immune response as the virus begins to replicate rapidly.
Common symptoms of acute HIV infection include:
- Fever: Present in most cases, often accompanied by chills.
- Fatigue: A profound sense of tiredness or weakness that may not improve with rest.
- Muscle aches and joint pain: Generalized discomfort that resembles symptoms of the flu or other viral infections.
- Swollen lymph nodes: Particularly in the neck, armpits, or groin, due to immune system activation.
- Sore throat: May mimic a mild viral pharyngitis.
- Skin rash: Appears in some cases, often as flat or slightly raised red spots on the trunk and upper body.
- Headache: A frequent but non-specific symptom.
- Gastrointestinal symptoms: Such as nausea, vomiting, and diarrhea, though these are less common.
These symptoms typically last for 1 to 2 weeks and may resolve spontaneously without treatment. However, their transient nature often leads to misdiagnosis or being mistaken for a common viral illness, such as influenza or mononucleosis.
It is critical to note the following:
- Not all individuals will experience symptoms during acute HIV infection.
- Even in the absence of symptoms, HIV can still be transmitted to others and continues to replicate actively, potentially causing long-term harm to the immune system.
- Testing is the only definitive way to confirm HIV infection. Modern tests, including antigen/antibody combination tests, can detect HIV as early as 2 to 4 weeks after exposure.
- Opportunistic infections: These are infections that occur more frequently and are more severe in individuals with weakened immune systems (e.g., pneumonia, tuberculosis).
- Certain cancers: Individuals with HIV are at increased risk for specific cancers, such as Kaposi’s sarcoma and non-Hodgkin lymphoma.
- Neurological complications: HIV can affect the brain and nervous system, leading to conditions such as HIV-associated dementia or other cognitive disorders.
- Chronic health conditions: People with HIV may also face increased risks for conditions like heart disease, kidney disease, and liver complications.
- Use condoms consistently and correctly: Condoms are effective in reducing the risk of HIV transmission during sexual activity.
- Pre-exposure prophylaxis (PrEP): This medication can be taken by HIV-negative individuals at high risk to lower their chances of contracting HIV.
- Regular testing: Regular HIV testing and awareness of your and your partner’s status can significantly reduce the risk of transmission.
- Avoid sharing needles or syringes: If you use drugs, use new, sterile equipment to prevent sharing.
- Educate and communicate: Open conversations about sexual health with partners can lead to safer practices and informed decisions.
Stages of HIV Infection: Symptoms and Progression
Understanding the HIV Window Period and Preventive Options
- Post-Exposure Prophylaxis (PEP): If you’ve had possible HIV exposure within the last 72 hours, PEP may be recommended. This preventive treatment, if started promptly, can lower the risk of HIV infection.
- Follow-Up Testing: If exposure occurred within the past 90 days, consider repeating the HIV test after the window period to confirm results.
- Pre-Exposure Prophylaxis (PrEP): For individuals at ongoing high risk of HIV exposure, daily PrEP is a proactive measure that significantly reduces the likelihood of infection.
Estimation of HIV risk
The table below provides an estimated risk of HIV transmission. However, we strongly recommend patients undergo a comprehensive consultation to better assess and discuss their individual risk.
| EXPOSURE | ESTIMATED RISK* |
|---|---|
| Receptive anal intercourse | 1 in 90 |
| With ejaculation | 1 in 65 |
| No ejaculation | 1 in 170 |
| Insertive anal intercourse | 1 in 666 |
| Not circumcised | 1 in 161 |
| Circumcised | 1 in 909 |
| Receptive vaginal intercource | 1 in 1000 |
| Insertive vaginal intercourse | 1 in 1219 |
| Semen splash to eye | <1 in 10000 |
| Giving oral sex | <1 in 10000 |
| Receiving oral sex | <1 in 10000 |
| Blood Transfusion (one unit) | 1 in 1 |
| Needle stick injury | 1 in 333 |
| Sharing injecting equipment (including chemsex) | 1 in 149 |
| Human Bite | <1 in 10000 |
*Assuming exposure is from a known HIV positive individual not on ART. ART = Antiretroviral therapy
Reference: Fiona Cresswell, Laura Waters, Eleanor Briggs, Julie Fox, Justin Harbottle, David Hawkins, Martin Murchie, Keith Radcliffe, Paul Rafferty, Alison Rodger and Martin Fisher. UK guideline for the use of post-exposure prophylaxis for HIV following sexual exposure, 2015. Int J STD AIDS. 2016 Aug;27(9):713-38.
Summary of HIV Window Period
Day 0 to 3 (Within 72 Hours)
What’s happening:
The virus has entered the body but has not yet established infection. Immediate action is critical to prevent replication.
Symptoms: None.
Testing available:
- Testing is not reliable at this stage.
- HIV Post-Exposure Prophylaxis (PEP) – Baseline HIV test required before starting PEP.
Day 10
What’s happening:
The virus has integrated into host cells and begun replicating. Viral load may remain below standard test detection levels.
Symptoms: Rare or none.
Testing available:
- HIV Proviral DNA Test
Day 12
What’s happening:
Active viral replication is underway, with a rapidly increasing viral load.
Symptoms: Mild flu-like symptoms may appear (fever, fatigue, muscle aches, swollen lymph nodes).
Testing available:
- HIV RNA PCR Test
Day 14 to 28 (2 to 4 Weeks)
What’s happening:
The immune system begins producing HIV p24 antigen, followed by measurable antibodies. This is the acute infection or seroconversion phase.
Symptoms:
- Fever and chills
- Fatigue
- Sore throat
- Swollen lymph nodes
- Rash
- Joint or muscle pain
- Headache
Testing available: - 4th Generation HIV Antigen/Antibody Test
- Rapid Fingerprick HIV-1/2 P24 Test
Day 28 and above (Over 4 Weeks)
What’s happening:
Detectable antibodies have formed, and antigen levels may start to decline. If untreated, HIV progresses into the chronic stage.
Symptoms:
- Symptoms may subside or become mild.
- Persistent fatigue, recurrent fevers, weight loss, and swollen lymph nodes may develop during chronic infection.
Testing available: - 4th Generation HIV Antigen/Antibody Test
- Standard HIV Antibody Test (ELISA)
- Rapid Oral Saliva HIV-1/2 Antibody Test (Oraquick)
Day 90 and above (Over 12 Weeks)
What’s happening:
By this point, nearly all individuals infected with HIV have detectable antibodies. Untreated HIV continues to replicate, causing progressive immune suppression.
Symptoms:
- Increased susceptibility to infections
- Unexplained fatigue
- Weight loss or persistent fevers
Testing available: - 4th Generation HIV Antigen/Antibody Test
- Standard HIV Antibody Test (ELISA)
- Rapid Oral Saliva HIV-1/2 Antibody Test (Oraquick)