A majority of individuals will manifest symptoms of acute HIV infection within days to weeks from time of exposure (16). A flu-like illness is common with fever, fatigue, headache, lymphadenopathy, and myalgia. A significant percentage of patients may exhibit a maculopapular rash or present with meningitis. Plasma viremia is often in the millions of copies/mL at this stage and CD4 cell counts typically drop to below the lower limit of normal (typically 500 cells/uL). With seroconversion symptoms subside and plasma viremia typically stabilizes to less than 10,000 copies/mL and CD4 cell counts increase often to the normal range. During this chronic phase, most patients are asymptomatic, but approximately half of infected individuals will progress to symptomatic disease or have CD4 cell counts fall to less than 200/uL within approximately 10 years if not treated (17). This severe immune deficiency results in a number of clinical manifestations such as opportunistic infections, cancer, dementia, anemia, and wasting.

Individuals with high plasma viral loads are also more likely to transmit HIV infection to their sex partner or infant. About 25% of infected pregnant women will transmit HIV to their infants, but the transmission rate is greater than 50% for those women with greater than 100,000 copies/mL (18).