amfAR, The Foundation for AIDS Research

Fact Sheet: GMT Acute HIV Infection (April 2014)

Click here to download printable PDF version. (French version) | (Spanish version)

What is Acute HIV Infection?

Acute HIV infection is the period shortly after someone has been infected with the HIV virus. During this period, the virus is in the body and can be transmitted, but it is likely that a traditional rapid or antibody-based HIV test will come out negative because the body has yet to develop the antibodies that fight HIV that these tests detect.  This period generally lasts up to three months.

Are there Symptoms for Acute HIV?
Many people experience no symptoms during acute HIV infection, but others experience flu-like symptoms, such as fever, headache, sore throat, swollen glands, a rash, and/or sores around the genitals. These symptoms are also similar to malaria, and people with acute infection are more often misdiagnosed with malaria than with the flu.

Get Tested Regularly!

Because acute HIV may not have symptoms, it is very important to get tested for HIV every 3–6 months. Below is some additional information on why testing is important to protect yourself and your community:

  • Depending on the country, between 20–50% of people living with HIV are unaware they are infected and therefore might infect others without knowing. Among those in the acute infection stage, a much larger majority is unaware of their status and risks unknowingly transmitting the virus.

  • Starting HIV treatment as soon as possible after infection may reduce the virus’s ability to replicate and decrease the likelihood of transmitting the virus to others. However, until national guidelines are changed, access to early treatment will remain difficult in many countries.

  • Protect your community! During the first few months of infection, you are at higher risk of transmitting to others. In the acute stage, the virus is highly concentrated in the body, so sexual transmission is made easier through the exchange of body fluids like blood, semen, and vaginal fluids. Transmission during acute HIV infection accounts for half of all new transmissions to other people.  

How is Acute HIV detected?

The most common HIV test is an antibody test (also known as an ELISA), which looks for antibodies that your body specifically makes in response to the HIV virus. These antibodies may not be present in the blood for several weeks to a few months following infection. Rapid HIV tests, done using blood or oral fluids, are antibody tests. This is why it is possible that your rapid test result could come back negative even though you have already been infected.

The second type of HIV test, nucleic acid testing (NAT), looks for the HIV virus itself. This test will detect the HIV virus as early as five days after infection, so it is an important test for diagnosing those recently infected with HIV.

The ELISA antibody test can come back negative or indeterminate for someone with acute HIV infection. However, the NAT will have a positive result during acute infection. A negative or indeterminate HIV antibody test and a positive RNA test strongly suggest acute HIV infection. 

Challenges in Acute HIV Detection

  • Nucleic acid testing can be expensive, meaning it is often unavailable in many settings and to those with limited financial resources.

  • Smaller clinics or health centers may not have the necessary resources to identify acute HIV infection and may tell someone they are negative when they are not.

  • Stigma and discrimination remain major obstacles in encouraging people to get tested routinely.

  • Access to early treatment for HIV-positive individuals is showing promising signs of reducing the probability of transmitting HIV to others. However, official guidelines are not yet recommending this, and national treatment guideline may render early treatment impossible in many countries. 

Why is Acute Infection Important for GMT Program Implementers and Activists?

As noted above, when a person has recently been infected with HIV (acute infection), it is more likely they can infect others through unprotected anal intercourse. This makes reaching out to GMT community members to help them understand what acute infection is all about very important. GMT educators and activists should help GMT individuals understand that if they have had unprotected anal intercourse sex and then develop flu-like systems a week or two later, they may have been exposed to HIV and should be tested right away, ideally with a nucleic acid test if it is available. They also should be using condoms and lubricant, as their condition may make it easier for them to infect others. We need to help our communities take control of the epidemic by seeking out ways to reduce HIV throughout the community.