Asymptomatic stage

Begins when the symptoms of primary infection subsides. During the asymptomatic stage of HIV infection the patient is well for some or many years.

• laboratory test values may sometimes show anaemia, neutropaenia, lymphopaenia and thrombocytopaenia
• CD4 count remains over 500 cells/mm3 (1)

The virus is not latent, rather it is replicating rapidly and infecting large numbers of CD4-positive macrophages and lymphocytes. Viral load is low because the intact immune system is continually clearing infected cells.

In untreated individuals the CD4 count reduces at a rate of 40-80 cells/mm3 per year but the time taken for progression from primary infection to symptomatic disease may vary widely (1).

Persistent generalized lymphadenopathy:

• is common
• is mild and often the patient is unaware
• affects cervical, axillary and inguinal nodes symetrically

Some conditions are more common during the asymptomatic stage of HIV infection:

• recurrent herpes zoster (shingles)
• seborrhoeic dermatitis
• pruritic folliculitis
• increasing severity of pre-existing psoriasis
• more severe hypersensitivity reactions
• thrombocytopenia

Reference:

• (1) The Medical Foundation for AIDS & Sexual Health (MedFASH) 2008. HIV for non-HIV specialists, diagnosing the undiagnosed: A practical guide for healthcare professionals secondary care to support improved detection and diagnosis of HIV in the UK