Symptoms | Progression | Effects

A female pharmacist sits with a male customer in the pharmacist consultation area and discusses his prescription and choice of medication viewing the details on a digital tablet. In the background a senior woman and granddaughter stand at the dispensing counter and are served by a female pharmacy assistant .
A female pharmacist sits with a male customer in the pharmacist consultation area and discusses his prescription and choice of medication viewing the details on a digital tablet. In the background a senior woman and granddaughter stand at the dispensing counter and are served by a female pharmacy assistant .

Shortly after infection, the virus temporarily replicates at a very high rate, in particular in the so-called CD4 helper cells which play an important role in controlling the immune system. This causes the number of immune cells in the intestinal mucosa to be reduced significantly, especially of those cells which represent the immunological memory (memory cells). This damage cannot be fully reversed by antiretroviral therapy.

On average, the maximum viral load in the blood and in semen is reached two and a half weeks and one month after infection, respectively. Due to the large amount of virus in the blood, semen, and the genital and rectal mucosa, the risk of infection is particularly high in this phase.

When the viral load in the blood increases, non-specific symptoms occur in the majority of the cases (referred to as primary infection, e.g. fever, exhaustion, fatigue or malaise, lack of appetite, headache, joint pain, heavy night sweats, swollen lymph nodes, skin rash, diarrhoea, pain when swallowing, or ulcers in the mouth). These symptoms usually subside after seven to ten days and are often mistaken for symptoms of flu or a travel-related disease.

The infection triggers an immune response in all infected persons, producing antibodies against HIV. They are usually detectable from about the third week after infection.

The acute infection phase is followed by a stage with no or only mild symptoms, which can last for several months to many years. But the virus continues replicating, causing damage to the immune system and internal organs such as the kidneys, the bones and the brain as well as the nervous system. The number of T helper cells and their functionality increasingly decline as the condition progresses.

Initially, the ensuing symptoms usually include non-specific disturbances in general well-being, skin and mucosal changes, gastrointestinal disorders (e.g. diarrhoea), persistent swelling of lymph nodes in several body regions, fever attacks, night sweats, and increased susceptibility to infections or longer recovery periods. This phase may be followed by a phase completely or largely free from symptoms. In some cases, complications may occur suddenly even though the person previously appeared to be completely healthy.

Once HIV has damaged the immune system to such an extent that life-threatening conditions such as Pneumocystis pneumonia or certain tumours such as Kaposi’s sarcoma occur, AIDS is present.