Becoming HIV antibody positive

Most people who become infected with HIV do not notice at the time that they have been infected. Some have a short illness soon after they become infected. This is called 'seroconversion illness' because it coincides with the time that blood tests for antibodies to HIV become positive.

This stage of HIV infection is also sometimes called primary HIV infection or acute HIV infection.

The severity of symptoms at this stage can vary considerably between people - they can be so mild as to go unnoticed or so severe that admission to hospital is required.

The highest likelihood of transmitting infection from one individual to another is during the seroconversion period.

Common symptoms include:

• Prolonged fever (4 to 14 days) and aching limbs
• Red blotchy rash over the trunk
• Sore throat (pharyngitis)
• Ulceration in the mouth or genitals
• Diarrhoea
• Severe headaches
• Aversion to the light. 

Remember that these symptoms could be caused by other infections; flu, glandular fever, tonsillitis and a serious herpes attack have similar symptoms to those reported in seroconversion illness.

Asymptomatic HIV infection

Initially, any damage caused by HIV has no outward sign or symptom. This is called asymptomatic infection, which may last for many months or years.

People who have HIV and feel 100% will usually have some signs of immune damage detectable by laboratory tests. Doctors use two key tests to see how active HIV is and what impact it is having on the immune system. 

These tests are a CD4 cell count, which gives a rough indication of the strength of the immune system, and an HIV viral load test, which shows how active HIV is in the body.

You can read more about CD4 and viral load in the NAM patient information booklet Viral load and CD4. There is also information on these and other key monitoring tests on our website namlife.org and in the monitoring the immune system section of aidsmap.com.

Symptomatic HIV infection

The longer someone lives with HIV without treatment, the greater their risk of developing symptoms or infections. These can be caused by infections that take advantage of a weakened immune system or certain cancers.

The infections are called opportunistic infections because they are infections with pathogens that are around us all the time – and which our immune systems can normally fight off with no problems.

When someone gets ill in one of these ways, he or she is said to have symptomatic HIV infection.

It is important to understand that most of these are the symptoms of particular conditions caused by opportunistic infections, and not directly by HIV itself. Therefore there are a wide range of possible symptoms, with particular ones associated with particular opportunistic infections. Having HIV does not come with a set of defined symptoms.

An AIDS diagnosis

Before coming to a diagnosis of AIDS, doctors look at a variety of symptoms and tests. There is no single test for AIDS and an AIDS diagnosis is usually based on the presence of certain illnesses and cancers.

In the US, if your CD4 cell count falls to below 200, the level at which you become vulnerable to serious infections, you are also diagnosed as having AIDS.

Different experiences

The way HIV disease progression is often described suggests that there is an inevitable, one-way course in HIV infection. It implies that everybody with HIV will be initially well, then get abnormal CD4 and viral load test results before becoming ill with minor illnesses, and finally go on to develop severe and fatal illness.

This used to be the pattern but many people have had an illness which has led to them being diagnosed with AIDS, and then completely recovered and lived for many years, even decades, in very good health.