From the Guidelines
Acute HIV symptoms resolve because the body's immune system initially responds to the infection by producing antibodies and cytotoxic T cells that temporarily control viral replication. During acute HIV infection, which typically occurs 2-4 weeks after exposure, patients may experience flu-like symptoms including fever, sore throat, rash, muscle aches, and swollen lymph nodes. These symptoms usually last 1-2 weeks before resolving spontaneously. This resolution occurs as the immune system partially controls viral replication, leading to a decrease in viral load and associated inflammation. However, this doesn't mean the infection is cleared - HIV establishes reservoirs in CD4+ T cells and enters a clinical latency phase that can last for years. According to the 2016 recommendations of the international antiviral society-USA panel 1, initiation of antiretroviral therapy (ART) is recommended as soon as possible in the setting of acute HIV infection, as it reduces the size of the latent HIV reservoir, reduces immune activation, and may protect against infection of central memory T cells. Some key points to consider include:
- Initiation of ART prior to the development of HIV antibody positivity has several benefits, including reducing the size of the latent HIV reservoir and reducing immune activation 1.
- Early therapy does not prevent the establishment of the latent HIV reservoir, but benefits are maximal during the first few weeks after HIV infection and are apparent up to the first 6 months after infection 1.
- Planned discontinuation of early ART after a specific duration of treatment is not recommended outside research settings, as the benefits do not persist and the subsequent viral rebound is associated with increased clinical events and the potential for transmission 1. The current recommendation is to initiate ART as soon as possible, regardless of symptom status, to suppress viral replication and prevent disease progression.
From the Research
Acute HIV Symptoms Resolution
The resolution of acute HIV symptoms can be attributed to the body's immune response to the infection.
- The immune system's ability to mitigate peripheral T and B cell dysfunction, limit seroconversion, and enhance cellular antiviral immunity despite persistence of infection in lymphoid tissues is crucial in resolving acute symptoms 2.
- The timing, nature, and function of the diverse immune responses induced during acute infection play a significant role in determining the outcome of the infection 2.
Immune Response to HIV
The immune response to HIV is complex and involves multiple components, including:
- CD4 and CD8 T-cell responses with polyfunctional profile, which are associated with nonprogressive infection 3.
- Broader neutralizing antibodies, which are detected 3-4 years after infection, but show no efficacy in the control of HIV replication 3.
- Innate immune responses, such as mucosal barriers, complement, DCs, macrophages, and NK cells, as well as cytokine/chemokine profiles, which attain great importance in acute HIV-1 infection 4.
Factors Influencing Symptom Resolution
Several factors can influence the resolution of acute HIV symptoms, including:
- Early anti-retroviral therapy administration, which can mitigate peripheral T and B cell dysfunction, limit seroconversion, and enhance cellular antiviral immunity 2.
- Genetic factors, such as human leukocyte antigen (HLA) class I alleles, particularly HLA-B5701, which are associated with nonprogressive infection 3.
- The interplay between retroviruses and innate immunity, which can either prevent or promote the progression of the infection 4.