HIV infection is a progressive disease, meaning that it typically worsens over time. In the early stages, the symptoms may be mild and easily mistaken for an illness like the flu. However, as the disease advances and breaks down the immune system, other, more serious symptoms can develop. It’s important, therefore, to recognize the signs of HIV at different stages of the infection. By doing so, you can be tested and begin taking life-extending HIV treatment. “Even if you don’t have symptoms," says Linda-Gail Bekker, MD, an infectious-disease specialist based in South Africa and president of the International AIDS Society, “early testing and treatment confers far better health and near-normal life expectancy.” Here’s a list of HIV symptoms along with the stage of the infection in which they likely appear: Although these signs typically appear within 7 to 14 days of exposure, they can also crop up as early as 3 days. Around 30 percent of people with ARS will develop a maculopapular rash of pink to red bumps, usually on the upper half of the body. The rash will sometimes gradually converge into larger, raised hives. Other common ARS symptoms include:
FeverFatigueHeadacheSore throatMuscle achesJoint painSwollen lymph nodesNight sweatsNauseaDiarrhea
14 to 28 Days After Exposure
By around day 14, the virus will begin to stop multiplying rapidly. Although some people can experience ARS symptoms for up to three months, most people will start feeling better within two weeks, as the immune system gradually brings the infection under control. The exception: a symptom called lymphadenopathy, the sometimes painful swelling of lymph nodes in areas of the body such as the neck, armpits, or groin region. Even when the other symptoms have disappeared, lymphadenopathy may continue for months or even longer. “The important thing to remember is that the resolution of symptoms does not mean the infection is gone,” says Dennis Sifris, MD, an HIV specialist with the Lifesense Disease Management Group, located in South Africa. “HIV is not like hepatitis, which can spontaneously clear. HIV is forever and is better treated sooner rather than later.”
29 Days to 20 Years After Exposure
The chronic stage of infection occurs once the immune system brings the virus under control. During this phase, HIV will go into hiding, where it resides in various cells and tissues throughout the body in a dormant state known as latency. HIV latency can persist without symptoms for 10 years or more, although some people may experience signs within a year or two. During the early chronic phase, lymphadenopathy may be the only notable sign of an HIV infection. In some cases, the glands may be visibly enlarged and reach up to an inch or more in size. If the condition persists for more than three months, it’s referred to as persistent generalized lymphadenopathy (PGL). Even during latency, the virus will multiple imperceptibly and gradually deplete immune cells known as CD4 T-cells. As immune deficiency develops, a number of nonspecific symptoms are likely to appear, including:
Oral candidiasis (thrush), a fungal infection that causes the formation of creamy, white lesions on the sides of the tongue and lining of the mouthUnexplained fevers and drenching night sweats that soak through bedsheets and nightclothesSevere, uncontrolled diarrhea that lasts for more than three days
Each of these symptoms is commonly seen in persons with immune deficiency. They may, in some cases, be caused by HIV itself or by an infection that has yet to be diagnosed.
Later-Stage HIV and AIDS
If left untreated, HIV will almost invariably lead to symptomatic disease. There is no timeline or pattern as to when this might occur. Generally speaking, the lower a person’s immune health (as measured by the CD4 count), the greater the risk of certain illnesses. We refer to these illnesses as “opportunistic” because they are harmful only when a person’s immune defenses are down. At a certain point, if still untreated, the depletion of CD4 T-cells can lead to a stage of disease called AIDS, or acquired immunodeficiency syndrome. This is when the most serious opportunistic infections tend to occur. AIDS is officially defined as either having a CD4 count under 200 or the presence of at least one of 27 different AIDS-defining conditions as outlined by the Centers for Disease Control and Prevention (CDC). Symptoms in later-stage HIV and AIDS include viral, bacterial, fungal, and parasitic infections as well as cancers like invasive cervical cancer and non-Hodgkin lymphoma. These infections affect the organs and other areas of the body, including:
Lungs (bacterial pneumonia, tuberculosis, pneumocystis pneumonia)Skin (shingles, Kaposi sarcoma)Gastrointestinal system (mycobacterium avium complex, cryptosporidiosis)Brain (AIDS dementia, cryptococcal meningitis)Eyes (cytomegalovirus retinitis, herpes zoster ophthalmicus)Blood (salmonella septicemia)
