1.4. What are the stages of the disease?

After you have been infected with HIV, the virus follows four stages of infection. During the first two stages you normally do not see any symptoms of the disease. AIDS-related symptoms usually only appear during the final two stages.
Stage 1: Acute infection
* This is when you first come into contact with HIV. This stage - sometimes called the 'window period' - lasts approximately 6-9 weeks. Most people do not notice that they have been infected.
* Some people have a short illness soon after they become infected such as a sore throat, ulcers in the mouth or genitals, a fever or a rash, diarrhea, severe headaches or, rarely, a more severe illness such as meningitis as a result of severe immune suppression.
* During this stage, the result of an HIV test will show that you do not have HIV because the test is looking for antibodies for HIV and as yet your body has not developed any. Antibodies are a type of protein produced by the immune system when it detects a foreign substance that may be a threat to the body. So you should go for another test a few months later.
* Remember that the symptoms described above could also be caused by other infections such as flu, glandular fever and tonsillitis.
Stage 2: Asymptomatic HIV infection
* This is called the asymptomatic stage as you will have no signs or symptoms of HIV and will probably feel completely healthy.
* Because you may feel and look fine on the outside, two tests are extremely important as they will help you to understand how strong your immune system actually is. Signs of immune damage can be detected by two laboratory tests:
- CD4 cell count
CD4 cells are cells in your body attached to the immune system. As HIV attacks the immune system, so the number of CD4 cells drop. Changes in CD4 cell count are helpful in showing whether or not HIV is damaging the immune system. A normal CD4 cell count in a person without HIV varies between 400 and 1600 cells per mm3. Immediately after a person becomes infected with HIV the CD4 cell count is likely to fall to a level several hundred cells below normal.
- Viral load test
This test detects the amount of HIV in your blood. The amount of virus is counted in the form of 'copies' per milliliter (ml) of blood: 10,000 copies per ml is low, and more than 100,000 copies per ml is high. Your viral load can go up briefly if you have an infection. Single viral load results don't matter as much as the trend in your viral load results.
* The HI virus is always active in your body once you are infected. HIV actively increases during the asymptomatic period, mainly in the lymph nodes and lymphoid tissue, which are a perfect environment for the infection of new CD4 cells.
* It is important to note that while you may feel fine, you are still able to infect others with the virus through unprotected sex and exposure to blood. The duration of this stage varies widely from one person to another. Some people decline rapidly in 2 years but 10 to 15% of people may show no signs of progression for 10 or more years.
Stage 3: Symptomatic HIV infection
* Now the immune system is fighting the virus while it infects more and more cells. For many years, the immune system can control the virus, but eventually the immune system starts losing the battle. The virus begins to destroy the CD4 cell population.
* As the CD4 counts continue to drop, signs and symptoms more specific to HIV disease may arise, such as:
- Weight loss
- Diarrhea
- Oral thrush and ulcers
- Shingles (a painful skin rash)
- Meningitis or peripheral neuropathy
Stage 4: Acquired Immuno-deficiency Syndrome (AIDS)
* Because there is no single way for doctors to make an AIDS diagnosis they look at a number of different factors, which may indicate that the HIV infection has progressed to AIDS.
Note: this is different from testing for HIV - See 3. How do I know my HIV status?
* You have AIDS when you are HIV positive, your CD4 is below 200 and you suffer from one or more of these secondary infections:
- Tuberculosis (TB)
- Types of cancers such as Kaposi's Sarcoma, cervical cancer and Lymphoma (enlarged lymph nodes, liver or spleen)
- Pneumonia (PCP)
- Meningitis/encephalitis
- HIV Dementia
Many of these opportunistic (secondary) infections can be treated at any stage of HIV disease.
For more information about treatment, see 5. HIV and AIDS Treatment


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