Concern about possible infection with HIV following sexual episodes is extremely common. Very frequently minor symptoms associated with a host of relatively minor conditions can assume a sinister significance in the mind of someone who has perhaps had a condom accident or simply an episode of unprotected sex.

These symptoms are very varied and generate a huge number of clinic attendances and also worried enquiries to our Sexual Health Forum.

If symptoms are symptoms of HIV then they must follow a sexual episode with an HIV positive person. Obviously, if a sexual partner does not have HIV then transfer of HIV is impossible. Having or acquiring a different STD or STI such as syphilis, gonorrhoea or hepatitis will increase the chances of contracting HIV from an HIV positive person.

The early symptoms of HIV when they appear are referred to by clinicians as Acute Retroviral Syndrome or Primary HIV infection. The process of becoming HIV positive after infection is called seroconversion.

Common symptoms include fever, headache, fatigue, swollen lymph glands and also a rash. Sometimes abdominal pain, diarrhoea, nausea, sickness may be features. Occasionally oral thrush and severe sore throat may also be features of ARS.

These symptoms may be mild but more often are quite severe and because they are so severe they may compel the patient to seek medical advice. These early symptoms may appear in between 50% and 80% of newly infected HIV positive people. They usually will last from a week to three weeks and then often will spontaneously improve. During this phase patients will be highly infectious due to soaring levels of HIV virus in their bodies.

HIV virus replication at this time is very rapid and the seroconversion illness associated with it might be severe. The level of virus detectable in the blood is referred to as the Viral Load and is counted as copies per ml. The immune cells, which are referred to as CD4 cells will often plummet during this time, so other infections to which we are normally well defended against may appear.

The usual sequence during early HIV infection is for the Viral Load to increase very substantially and the CD4 cell number to fall dramatically. This will usually stabilise over the ensuing few months and does not usually require treatment. Occasionally, patients with ARS will be so unwell that they may require intervention with anti HIV medications called HAART or Highly Active Anti Retroviral Therapy or sometimes just known as ARV or Anti RetroVirals.

The only way to reliably diagnose HIV is to have an HIV test. Testing during the early stages of HIV is certainly possible and sometimes needs a concerted approach. A high clinical suspicion by an experienced doctor who picks up on the clues a patient gives together with one of HIV DUO testing, HIV PCR testing and HIV antibody testing will give a definitive answer.

Dr Sean Cummings
MBBS DRCOG DFFP LLM TGP MRCGP