4.  Immune System Decline

The virus appears to slowly damage the immune system for a number of years after infection (perhaps because the body is able to keep it in check during this time). In most people, however, a faster decline of the immune system occurs at some point, and the virus rapidly replicates. This damage can be seen in blood tests, such as lowered T-cell counts, before any actual symptoms are experienced.

People who are HIV-positive should see a doctor to monitor their immune systems. By getting lab indicators (such as the viral load test) and observing how they are changing over time, they can get a better sense of whether HIV has already caused any damage to their immune systems. As mentioned above, a development in the last couple of years in the treatment of HIV disease is what doctors call "Early Intervention" or "Early Care." The principle behind this concept is that early rather than late medical care may give people better chances of survival and better quality of life. It is extremely important that people with HIV learn that they have to see a doctor even if they feel fine at the moment because the virus could be already damaging their immune systems.

Understanding that HIV Disease begins immediately after infection enables us to begin treating infected persons before symptoms appear. This important medical advance has significantly extended the lifespan -- and the hope -- of HIV-infected people.

5.  Mild, Non-Specific Symptoms

Once the immune system is damaged, many people will begin to experience some mild symptoms (skin rashes, fatigue, slight weight loss, night sweats, thrush in the mouth, etc.). Most, though not all, will experience mild symptoms such as these before developing more serious illnesses. Although one’s prognosis varies greatly depending on one’s ability to access support, services and preventative treatment, it is generally believed that it takes the average person five to seven years to experience their first mild symptom.

These symptoms are not specific to AIDS. However, they should be of concern to people who have tested positive to HIV. Usually, symptoms occur when the virus has already caused considerable damage to the immune system. For that reason, people with HIV should not wait until symptoms appear to get medical treatment. Also, people with high risk for HIV should not wait to get symptoms to take the HIV-antibody test.

If you are a person with HIV experiencing any symptoms, we suggest that you have them checked by a health care worker.

6.  More Severe Symptoms; Opportunistic Infections and Diseases

When immune system damage is more severe, people may experience opportunistic infections (called "opportunistic" because they are caused by organisms which cannot induce disease in people with normal immune systems, but take the "opportunity" to flourish in people with HIV). Most of these more severe infections, diseases and symptoms fall under Health Canada's definition of full-blown "AIDS." In a Windsor study of gay men, the median time to receive an AIDS diagnosis among HIV-infected men is 10-11 years. (Again, this statistic predates the advent of more powerful anti-HIV drugs.)

Receiving an AIDS diagnosis does not necessarily mean that the person will die soon. Some people have lived many years after their diagnosis. However, it is extremely important that people in this stage of HIV disease get adequate care for any symptoms or conditions that develop.

People with an AIDS diagnosis have coined the term "living with AIDS" to describe their experience. We prefer this term over others because it implies empowerment which may be crucial in maintaining a positive frame of mind and possibly even in surviving longer. As the term "HIV-disease" becomes more common, many people are also using the term "living with HIV" to refer to anyone who has the virus.

Does everyone who has HIV eventually get sick? Nobody knows.

Many researchers believe that, in some small percentage of people with HIV, the immune system may be able to defeat the virus. As existing treatments are used earlier in the course of HIV disease and new treatments are developed, these, too, will postpone, and possibly prevent, illness. Unfortunately, however, studies show that the majority of untreated people do eventually become ill from HIV. Long-term studies of San Francisco gay men infected with HIV between 1978 and 1980 have shown that by 1992, 85% had developed AIDS, and 15% remained symptom-free.

No one knows whether these men will eventually develop AIDS, or what percentage of the symptom-free men will develop AIDS in the years to come. Some long-term survivors may do so well because of their unique body chemistry, or access to a combination of medical, emotional and spiritual support, or something yet unknown to us. Others may find their health declining even with access to all of these things. We don’t really know the answer yet, although you can be sure scientists and researchers are searching for the common thread that links long-term survivors together.