The stages of HIV infection from initial acquisition to end-stage AIDS are described in Table 139-3. Acute HIV infection, essentially indistinguishable from a "flulike"
illness, usually goes unrecognized but is reported to occur in 50 to 90 percent of patients. 5 The time from exposure to onset of symptoms is usually 2 to 4 weeks, and the most common symptoms include fever, sore throat, fatigue, myalgias, and weight loss. Many experts now argue that it is beneficial to identify patients at this early stage because it may be the optimal time to begin antiretroviral therapy. The best method of establishing a diagnosis during this window (when HIV antibody serologic test results are usually negative or indeterminant) is by quantitative analysis of plasma HIV RNA. Acute infection is associated with high-level HIV RNA viremia and a precipitous decline in CD4 cell counts, reflecting ongoing destruction of the host immune response. Acute symptoms last an average of 2 weeks, with clinical recovery accompanied by a significant reduction in HIV RNA levels and a moderate increase in CD4 counts.
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