During the early stages of HIV infection, known as acute retroviral syndrome (ARS), the viral load can be quite high while antibodies are still developing or undetectable. The window period between infection and antibody detection can last up to 3 months. Symptoms of ARS may include fever, rash, oral lesions, lymphadenopathy, and gastrointestinal or neurological issues. While viral RNA can be detected as early as 8 days, diagnosis is challenging during this period as serology may be negative. Treatment focuses on counseling, and antiretroviral therapy is generally not recommended according to Indian guidelines unless the CD4 count drops below 200.

1. HIV-AIDS early stage Medical question on HIV-AIDS

2. Discussion Acute HIV Seroconversion Syndrome/ Acute Retroviral Syndrome (ARS) Acute HIV infection is defined as the period between exposure to the virus and completion of the initial immune responses. This period varies but generally lasts 2-3 months. During this time, the antibody test may be negative for HIV, but the serum viral load (the amount of HIV virus in the blood) is detectable and can be quite high (millions of copies per milliliter). http://aids.gov/

3. Window period: It is the duration between the time of HIV infection and the production of measurable antibodies to HIV (varies form 3 weeks to 3 months) Window period of even up to 12 months has been reported (was in the setting of HCV co-infection) Antibody detection – 22 days P24 antigen detection – 18 days RNA detection by PCR – 12 days http://aids.gov/

4. Course of HIV infection Day 0 The individual is exposed to HIV, and infection begins. Day 8 Virus is detectable by RNA RT-PCR. The viral load more than doubles each day. CD4 and total WBC counts begin to decrease. 2-4 weeks Earliest antibodies – can be detected by newer assays. The viral load peaks and begins to decline. 20-24 weeks The viral load drops to the lowest also known as the set point. Seroconversion is complete and chronic HIV infection begins. http://aids.gov/

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6. Lymphoid organs & HIV Pathogenesis http://aids.gov/

7. Clinical features Fever and chills Lymphadenopathy Oral lesions: Pharyngitis Thrush Apthous ulcer Dermatologic: Rash may develop and is usually maculopapular, primarily on the trunk or proximal extremities. Hematological: Anemia thrombocytopenia http://aids.gov/

8. Neurologic: Aseptic meningitis AIDP Mononeuritis multiplex Proximal myopathy Encephalopathy or encephalitis Gastrointestinal: Nausea, vomiting, diarrhea Musculoskeletal: Joints may be asymmetrically swollen and tender Myalgiasare also common. http://aids.gov/

9. Clinical features http://aids.gov/

10. Diagnosis Serology for HIV antibodies are negative. Viral RNA can be detected by PCR as early as 8th day (highly sensitive but problem of false positivity) P24 antigen (low sensitivity) Certain studies have shown that longer the duration of ARS the more rapid the progression to AIDS (CD4 count <200) Prognosis http://aids.gov/

11. Treatment Counseling should be given to both the patient and partner. There are no adequate data to suggest ART is beneficial for ARS patients. ART in acute HIV is controversial and many trials are underway to clarify the long term benefits of ART in acute HIV infection. In India NACO guidelines do not advise ART unless the CD4 count is below 200. http://aids.gov/

12. NACO guidelines http://aids.gov/