Acute HIV infection
An untreated HIV infection has different stages. After infection, an acute HIV infection occurs. Because of its similarity to flu-like infections, acute HIV infection often goes unrecognized. The symptoms of acute HIV infection rarely last more than four weeks. In the subsequent latency phase, which usually lasts several years, there are usually no serious physical symptoms. This is often followed by the first illnesses that can be attributed to a moderately weakened immune system. Finally, AIDS-defining diseases occur when the immune system is severely impaired.
Today, HIV infection is easily treatable.
Diagnostics and therapy
One focus is on the diagnosis and treatment of patients with HIV disease. The latest advances in research are quickly implemented for our patients. In particular, patients with concurrent liver inflammation (hepatitis B or C) receive optimal treatment from us.
Acute HIV infection
Diagnostics
The HIV screening test used today is a combination test (so-called HIV combo test), which is able to detect the HIV p24 antigen and antibodies against HIV-1 and HIV-2. The 4th generation HIV screening tests routinely used today are able to detect an acute HIV infection in most cases after approx. two to three weeks, but a final test 6 weeks after the risk situation with a 4th generation HIV test is still recommended. The routine use of an HIV PCR is not recommended in practice as a screening test.
Therapy
The current data clearly indicate that early antiretroviral therapy can have a positive effect on the course of the disease and also helps to prevent further infections. Early therapy does not differ significantly from long-term HIV therapy in terms of the composition and choice of substances. Early therapy is now recommended by all international expert committees. Early treatment should be started by doctors experienced with HIV, e.g. as part of the Zurich Primary HIV Infection Study at the Clinic for Infectious Diseases at the University Hospital Zurich.
Cooperation
Chronic HIV infection
Diagnostics
Combined tests (so-called combo tests) are used for HIV screening, which detect both HIV antibodies against HIV-1 and HIV-2 as well as HIV-1 p24 antigen. In half of newly HIV-infected patients, the combined tests show the HIV infection within around 16 days of infection, but in the other half it takes considerably longer in some cases. Therefore, an HIV infection can only be ruled out with a negative 4th generation HIV test 6 weeks after the risk situation. For extremely worried people and people who have demonstrably had sexual contact with untreated HIV-infected patients, an HIV test as early as four weeks after risk contact may make sense. However, a negative test at this time is not proof of “HIV-negative” status; a final test is still indicated 6 weeks after potential risk. Combo tests are also available as rapid tests for doctors’ surgeries or HIV test centers; however, the sensitivity of these rapid tests in patients with acute HIV infection is significantly lower than the sensitivity of laboratory tests.
Therapy
The success of antiretroviral therapy against HIV-1 is unique in modern medical history. A previously almost 100% fatal disease has been transformed into a chronically treatable disease. If antiretroviral therapy is started early in accordance with international recommendations, the negative effects of the HIV-1 virus on the human organism can be minimized. This leads to an almost normal life expectancy in otherwise healthy HIV-infected people. In addition, patients undergoing successful treatment are no longer infectious, which is crucial for containing the pandemic. In the latest version of its guidelines, the International Antiviral Society-USA (IAS-USA) recommends that antiretroviral therapy (ART) should be offered to all HIV-infected patients, regardless of their CD4 cell count. The guidelines are based on the results of data from cohort studies, which have shown that the benefits of treatment clearly outweigh the risks. As ART is also a highly effective element of prevention, it makes sense to treat as many patients as possible as early as possible. To prevent resistance and improve efficacy, ART is usually a combination of different substance classes. Which combination is used is a complex decision in which the treatment history, side effect and resistance profile, concomitant diseases and drug interactions must be taken into account.
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