The initial symptoms of HIV-infection are usually vague. Occasionally, HIV-infected people experience an acute reaction following infection.
The majority of HIV-infected people experience a vague constellation of symptoms; symptoms similar to the symptoms of lymphadenopathy (Figure 4). These symptoms, that emerge over a period of time, may include: fever, night sweats and chills; weight loss; diarrhea; sore throat; swollen glands; difficulty in swallowing (dysphagia); fatigue; and depression.
Obviously, many of these minor ailments may be caused by a number of other illnesses. In HIV infection, these symptoms may (or may not) persist for months without apparent reason. In any persistent illness, a doctor should be consulted.
Approximately 10 to 30 percent of HIV-infected people experience an acute reaction to HIV infection. Acute means that the symptoms begin and end quickly, although they may be severe.
The symptoms of the acute reaction generally are fever, tremors, joint discomfort, headache, swollen glands about the head and neck, and muscle aches. Less frequently reported are pimples or rash, abdominal cramps, diarrhea, and hives. Some researchers describe the acute reaction as being similar to the flu, others call it mononucleosis-like. Historically, the acute reaction appears 3 to 12 weeks after exposure, apparently coinciding with the appearance of anti-HIV antibodies in the blood.
The mouth, face, head, and neck are the areas where the first visible signs of HIV infection often appear. In lymphadenopathy, the lymph nodes about the head, face, and neck are often the first to swell. They swell during other infections too, such as for a cold or flu.
In many ARC or AIDS patients, the mouth, face and head are also where the first opportunistic infections occur. The most common are 1) oral Candidiasis (white spots or patches on the tongue or the mucous membranes of the cheeks); 2) oral hairy leukoplakia (fuzzy white spots on the tongue caused by a rare mouth fungus which does not rub off in AIDS patients, as does the hairy tongue caused by smoking); and, 3) herpes zoster blisters (large, painful pus-filled pimples which follow the path of a nerve under the skin). Herpes zoster is relatively common among people who are not infected with HIV.
A person's blood can be tested for the presence of HIV antibodies. Two tests are commonly used in combination: the ELISA and the Western blot. Again, these test detect the presence of anti-HIV antibodies, not the presence of HIV. Isolating and culturing (growing) HIV is too complicated for doctor's offices and similar settings. The antibody tests are easy, accurate, and inexpensive.
ELISA stands for "enzyme-linked immunoabsorbent assay," also called the EIA. Although the human body makes several anti-HIV antibodies, ELISA detects the antibodies directed against the HIV's protein coat. If the ELISA finds the evidence of anti-HIV antibodies in the blood, then the person tested is considered seropositive ("blood positive").
The ELISA is very sensitive, meaning it detects small amounts of antibodies.
However, it is so sensitive that it can be fooled by proteins or antibodies unrelated to HIV. Consequently, in normal testing procedures, ELISA-positive samples are tested again by the Western blot. The Western blot tests is saved for confirmation because it is difficult (thus expensive) to perform. The Western blot test is very specific, meaning it is exact in what it "sees." The Western blot eliminates most of the mistakes that ELISA makes from being too sensitive. The Western blot is an interpretative test, that is, an experienced technician must "read" it, thus human errors are possible or the test can be indeterminate.
These blood tests are accurate but not perfect. Both false-positives and false-negatives can and do occur, although statistically they are very rare. In false-positive results, the tests are fooled by proteins that resemble anti-HIV antibodies. ELISA false-positives are statistically related to: ongoing pregnancy, if it's not the first; severe renal (kidney) failure; recent organ transplant; some forms of cancer or rheumatoid arthritis; the flu vaccine; and lab errors. Where immunosuppression (weakened immune system) is present, false positives may occur. (Alcoholism and drug abuse may cause immunosuppression).Also, patients have 'passively acquired" anti-HIV antibodies from transfusions of gamma- and immuno-globulins fractions of whole blood that contained anti-HIV antibodies, but not HIV itself. Overall, the predictive value of ELISA is claimed to be better than 99% accurate 6 months after exposure. The accuracy of the combined tests, for seropositivity, is greater than 99.9 percent, according to research studies.
Again, these blood tests detect the presence of antibodies in the blood. Antibodies do not develop immediately after infection. Generally, antibody development requires a few days or a few weeks. There is a "window period" between the time of actual infection and the time at which antibodies are detectable in the blood. During this "window," a person could be infected and test seronegative.
According to the most recent information, involving a small number of cases where the time of HIV infection was actually known, HIV antibodies developed to detectable levels in the blood within 14 weeks. Using this information, and adding additional time for safety's sake, the window period currently is considered to be 6 months.
Thus, if a person tests negative for anti-HIV antibodies six months after a known exposure, they are probably not HIV-infected. Prudence suggests that anyone exposed to HIV should be tested at 3 month intervals up to a year after exposure.
Finally, different varieties (strains) of HIV exist. Different strains may have slight differences in their proteins coats. Since antibodies are created to match the protein coat of a virus, anti-HIV antibodies differ from person to person and HIV strain to HIV strain. The ELISA test in current use detects both HIV-I and HIV-2, the latter with 60-90% accuracy. A separate HIV-2 test is also available.
If a person's blood contains antibodies to HIV, this means one of three things:
I) The person was exposed to HIV, their antibodies defeated the virus, and the virus is no longer present in the person's body. This situation seems very unlikely. Historically, the presence of anti-HIV antibodies has indicated the presence of HIV, except in cases of "passively-acquired antibodies (see above).
2) The person is still carrying the HIV virus, but will not develop any AIDS-related disease. However, the person may be a carrier and may be able to transmit HIV infection. This situation is also unlikely. The percentage of people who are seropositive and who remain healthy is decreasing as the AIDS epidemic ages.
3) The person is carrying HIVs and eventually will develop lymphadenopathy, ARC, or AIDS. At the outset of the AIDS epidemic, 10 years ago, it seemed that only five to ten percent of those infected became ill. According to recent information, now more than two-thirds of antibody positive individuals get sick, and the percentage continues to grow as the AIDS epidemic matures.
If you suspect you are infected, or just wish to know your HIV status, DO NOT go to your local Red Cross clinic and donate blood in order to get tested.
A few phone calls should locate a testing center near you. Individuals may want to travel a distance to testing centers better suited to their needs. The Centers for Disease Control (CDC), a branch of the U.S. Public Health Service, has established a number of free test sites around the country, called alternative test sites. These offer an alternative to local doctors or hospitals, which may be required to report the results to insurance companies or to their state government.
These alternative test sites are not evenly distributed around the country. They are located in areas where AIDS is most common. Sometimes alternative test sites are set up by community request. Free or inexpensive AIDS testing centers have also been set up by state governments and private organizations. Ideally, a person being tested receives education and psychological counseling both before and after antibody testing.
Testing centers differ in quality, confidentiality, the amount of time it takes to get an appointment (ranging from no appointment necessary up to months), and the time it takes to get a test result (2 days to 3 weeks). It may be wise to call and question the testing center about their procedures before arranging an appointment.
To locate the testing center nearest to you, contact your city, county, or state Health Department; your local AIDS-service organization; or call the NATIONAL AIDS HOTLINE: 1(800) 342-AIDS, and ask for information on testing sites in your area.
When something is kept confidential, it is kept secret. People who are seropositive may wish to keep their antibody status secret because many people have lost their jobs, their apartments, and their friends after their seropositive status became known. Also, seropositive people or even people at high risk for being HIV-infected may not be able to obtain health insurance.
Tests performed by medical doctors and hospitals are not necessarily confidential. In some areas, doctors, hospitals, and medical-testing laboratories are required by law to report seropositive people to local health authorities. In addition, any tests performed in these settings are recorded, either on paper or in a computer. Generally, these records can be obtained by court subpoena.
The laws protecting patient confidentiality vary from state to state. Your city or state health department or local AIDS-service organization should have information on local laws.