Natural history and prognosis of HIV infection

Once the transmission of HIV occurs through exposure to HIV-containing fluids, the host’s cells transfer the virus to the local immune system, including t-cells, macrophages and dendritic cells.

The natural history of HIV infection may be characterised by:

• acute human immunodeficiency virus (HIV) infection/primary HIV infection/acute retroviral syndrome
  • is the period just after initial HIV infection
  • presentation is often clinically indistinguishable from infectious mononucleosis
  • more than 60% of patients experience a flu-like illness at the time of infection
  • risk of onward transmission is particularly high during primary HIV infection due to high viral load but are often unaware they have HIV and may even test antibody negative
• asymptomatic stage
  • begins when the symptoms of primary HIV infection subside (if they occur at all)
  • usually no overt clinical signs or symptoms of HIV infection during this stage and the individual may be well for many years
• symptomatic stage
  • results from progressive immunosuppression due to untreated HIV infection
• symptomatic, AIDS defining
  • AIDS defining infections and malignancies are present (1,2)

Prognosis:

• various studies have reported the dramatic decreases in mortality among individuals infected with human immunodeficiency virus (HIV) since the widespread introduction of highly active antiretroviral therapy (HAART) in industrialized countries
• in industrialized countries, persons infected sexually with HIV now appear to experience mortality rates similar to those of the general population in the first 5 years following infection, though a mortality excess remains as duration of HIV infection lengthens
• individuals exposed to HIV through intravenous drug use had a higher excess risk of death than persons infected sexually with HIV (3)

Reference:

• (1) Health Protection Surveillance Centre (HPSC) 2016. Guidelines for the Emergency Management of Injuries and Post-Exposure Prophylaxis (PEP)
• (2) The Medical Foundation for AIDS & Sexual Health (MedFASH) 2016. HIV for non-HIV specialists. Diagnosing the undiagnosed
• (3) Bhaskaran K et al. Changes in the risk of death after HIV seroconversion compared with mortality in the general population.JAMA. 2008 Jul 2;300(1):51-9