Patient information: Symptoms of HIV infection (Beyond the Basics)
- Paul E Sax, MD
Paul E Sax, MD
- Clinical Director, Division of Infectious Diseases
- Brigham and Women's Hospital
- Professor of Medicine
- Harvard Medical School
OVERVIEW OF HIV SYMPTOMS
It is important to recognize symptoms of HIV as soon as possible since early diagnosis and treatment will prevent serious illness. Early treatment will also reduce your chances of transmitting the virus to others.
This article discusses the early signs and symptoms of HIV and the groups that are at risk for becoming infected with HIV. A separate article discusses testing for HIV. (See "Patient information: Testing for HIV (Beyond the Basics)".)
WHO IS AT RISK FOR HIV?
HIV infection is usually acquired through sexual intercourse or exposure to infected blood or body fluids. This may occur:
●During sexual contact with an infected person, especially if you have unprotected vaginal or anal sex
●By sharing needles or syringes used by an infected person.
Transmission from a pregnant woman to her baby may occur during pregnancy, birth, or breastfeeding, although this is uncommon with the use of HIV medications during and after pregnancy.
HIV infection is NOT spread by casual contact.
Certain individuals may have an increased risk of HIV infection, including the following:
●Men who have sex with men
●Injection drug users who share needles or "works"
●Sexual partners of people who are infected with HIV
●People with a history of a sexually transmitted disease
●Victims of sexual assault (see "Patient information: Care after sexual assault (Beyond the Basics)")
●Men and women who have unprotected sex with multiple partners
●Men and women who exchange sex for money or drugs or have sex partners who do
●Anyone who is accidentally stuck with a needle or sharp in a healthcare facility
●People who received a blood transfusion or other blood products before 1984
Symptoms of early HIV infection — Early symptoms of HIV infection develop in 50 to 90 percent of people who are infected, usually beginning two to four weeks after exposure to HIV. The initial group of signs and symptoms is referred to as primary or acute HIV infection.
Because the signs and symptoms of primary HIV may be similar to other common illnesses such as the flu, most people do not initially realize that they have HIV. However, HIV infection is highly contagious at this early stage because there are large amounts of the virus in the blood and other bodily fluids. Recognizing symptoms early, being tested for HIV, and starting HIV treatment as soon as possible can help to decrease the risk of transmitting HIV to another person.
Body-wide symptoms — The most common body-wide signs and symptoms of acute HIV include fever (temperature above 100.4ºF or 38ºC), sore throat, headache, and muscle and joint pain. These flu-like symptoms last approximately two weeks.
During the second week of the illness, most people also have painless swelling of certain lymph nodes, including those in the armpits and in the neck. Although the lymph nodes decrease in size after the first few weeks, swelling can linger.
Skin, mouth, genital symptoms — One characteristic feature of acute HIV infection is open sores or ulcers. These sores or ulcers can develop in the mouth, the esophagus (the tube that extends from the mouth to the stomach), the anus, or the penis. The ulcers are usually painful. However, only a small proportion of those with acute HIV develop these sores.
Many people also develop a rash of the skin about two to three days after fever. The rash usually affects the face, neck, and upper chest or may be more widespread. The rash usually lasts approximately 5 to 8 days.
Digestive symptoms — Many people with acute HIV infection develop nausea and vomiting, diarrhea, lack of appetite, and weight loss.
Respiratory symptoms — A dry cough is usually the only respiratory symptom associated with primary HIV infection.
Symptoms of advanced HIV infection — If HIV is not treated, the virus will cause progressive weakening of the immune system, a process which occurs at different rates in different people. Once significant damage to the immune system has occurred, which typically takes at least several years, patients with HIV can become infected with other organisms that usually don’t cause illness in people with normal immunity. These “opportunistic infections” can cause serious disease in patients with advanced HIV infection. Depending on the opportunistic infection, symptoms may include shortness of breath, blurred vision, fevers, and weight loss.
One of the most common opportunistic infections is yeast infection of the mouth or esophagus. Yeast infections are caused by Candida, a fungal organism that is normally found on the skin and in the mouth, intestinal tract, and vagina in healthy individuals. Certain yeast infections can occur in people without HIV, (eg, vaginal yeast infections) although people with HIV are at a higher risk for this and other types of opportunistic infections. (See "Patient information: Vaginal yeast infection (Beyond the Basics)".)
●Candidiasis of the mouth, also known as thrush, causes cream-colored, slightly raised patches in the mouth, soreness, and easy bleeding.
●Candidiasis of the esophagus may cause difficulty swallowing.
However, with diagnosis and treatment of HIV, the immune system can improve. Then the risk of opportunistic infections goes down. While the immune system is recovering, certain medications can help prevent any opportunistic infections from occurring in the first place. (See "Patient information: Preventing opportunistic infections in HIV (Beyond the Basics)".)
TESTING FOR HIV
HIV testing is the only way to determine if you are infected with HIV. Some avoid testing because they are worried about the possibility of a positive test result.
However, testing is encouraged because treatment for HIV is highly effective and is generally well tolerated. In addition, learning about the infection can improve your chance of living longer and being healthier. Furthermore, knowing your HIV status and taking precautions can greatly reduce your risk of transmitting the virus to others. (See "Patient information: Testing for HIV (Beyond the Basics)" and "Acute and early HIV infection: Treatment".)
WHERE TO GET MORE INFORMATION
Your healthcare provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Patient information: HIV/AIDS (The Basics)
Patient information: Blood or body fluid exposure (The Basics)
Patient information: Preventing HIV after unprotected sex or needle-sharing (The Basics)
Patient information: Tests to monitor HIV (The Basics)
Patient information: Screening for sexually transmitted infections (The Basics)
Patient information: Urethritis (The Basics)
Patient information: Kaposi sarcoma (The Basics)
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Patient information: Testing for HIV (Beyond the Basics)
Patient information: Care after sexual assault (Beyond the Basics)
Patient information: Preventing opportunistic infections in HIV (Beyond the Basics)
Patient information: Vaginal yeast infection (Beyond the Basics)
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
Epidemiology, clinical manifestations, and diagnosis of Pneumocystis pneumonia in non-HIV-infected patients
Acute and early HIV infection: Treatment
Acute and early HIV infection: Pathogenesis and epidemiology
Overview of primary prevention of opportunistic infections in HIV-infected patients
Screening and diagnostic testing for HIV infection
Techniques and interpretation of measurement of the CD4 cell count in HIV-infected patients
The adolescent with HIV infection
Global epidemiology of HIV infection
The natural history and clinical features of HIV infection in adults and adolescents
The following organizations also provide reliable health information.
●Centers for Disease Control and Prevention (CDC)
Toll-free: (800) 311-3435
●CDC (Centers for Disease Control and Prevention) National AIDS Hotline
English: (800) 342-2437
Spanish: (800) 344-7432
●CDC National Prevention Information Network (NPIN)
Toll-free: (800) 458-5231
●National Institute of Allergy and Infectious Diseases (NIAID)
●HIV/AIDS Treatment Information Service
Toll-free: (800) 448-0440
●AIDS Clinical Trials Information Service (ACTIS)
Toll-free: (800) 874-2572
Patient Support — There are a number of online forums where patients can find information and support from other people with similar conditions.
●About.com HIV/AIDS Forum
- Pilcher CD, Tien HC, Eron JJ Jr, et al. Brief but efficient: acute HIV infection and the sexual transmission of HIV. J Infect Dis 2004; 189:1785.
- Quinn TC. Acute primary HIV infection. JAMA 1997; 278:58.
- Pao D, Fisher M, Hué S, et al. Transmission of HIV-1 during primary infection: relationship to sexual risk and sexually transmitted infections. AIDS 2005; 19:85.
- Cohen MS, Shaw GM, McMichael AJ, Haynes BF. Acute HIV-1 Infection. N Engl J Med 2011; 364:1943.
- Le T, Wright EJ, Smith DM, et al. Enhanced CD4+ T-cell recovery with earlier HIV-1 antiretroviral therapy. N Engl J Med 2013; 368:218.
- Daar ES, Pilcher CD, Hecht FM. Clinical presentation and diagnosis of primary HIV-1 infection. Curr Opin HIV AIDS 2008; 3:10.
All topics are updated as new information becomes available. Our peer review process typically takes one to six weeks depending on the issue.