Becoming HIV antibody positive

HIV quickly replicates in the body of someone who is newly infected. Although the virus may be undetectable by test, at this time there is a high level of virus in the peripheral blood and HIV can be readily transmitted to someone else. This period is known as acute or primary infection.

It may take weeks or even months before the immune system reacts to the virus by developing antibodies with which to fight it, although the majority of people will develop antibodies to HIV within eight weeks. The development of antibodies to HIV is termed 'seroconversion'.

Some people do not notice any changes after infection, whereas others will experience a brief flu-like illness within days to weeks of exposure. Symptoms may include headache, diarrhoea, nausea and vomiting, fatigue, fever, aching muscles, rash, and/or enlarged lymph glands .

Researchers are still puzzling out whether generalisations can be made between the number and duration of symptoms experienced during primary infection and future disease course. Some studies suggest that the severity and length of symptoms during seroconversion indicate a faster progression to AIDS. Other studies maintain that the severity of symptoms indicate a robust immune response to HIV and predict a rapid decline in viral load.

While that question remains open, gathering evidence supports the premise that the highest likelihood of transmitting infection from one individual to another is during the seroconversion period. A recent Canadian study found that in nearly 600 individuals at all stages of HIV infection, 50% of all new (or 'onward') infections resulted from contact with someone in the stage of primary HIV infection.

Another recent study in Malawi found that in newly infected men, blood viral load was highest about 17 days after infection; seminal viral load reached a peak at 30 days. This finding sheds new light on transmission and, from a public health standpoint, is information that needs to be communicated to as broad an audience as possible. Knowing the high potential for infectivity should impact HIV counselling and prevention programmes, as well as counselling of newly diagnosed patients.