U.S. National Library of Medicine: “HIV and Opportunistic Infections, Coinfections, and Conditions,” “CD4 T Lymphocyte.”
HIV Symptoms
Most people don’t know right away when they’ve been infected with HIV. But they may have symptoms within 2 to 6 weeks after they’ve gotten the virus. This is when your body’s immune system puts up a fight. It’s called acute retroviral syndrome or primary HIV infection.
The symptoms are similar to those of other viral illnesses, and they’re often compared to the flu. They typically last a week or two and then go away. Early signs of HIV include:
- Headache
- Fatigue
- Aching muscles
- Sore throat
- Swollen lymph nodes
- A red rash that doesn’t itch, usually on your torso
- Fever
- Ulcers (sores) in your mouth, esophagus, anus, or genitals
- Headache and other neurological symptoms
If you have symptoms like these and might have come into contact with someone with HIV in the past 2 to 6 weeks, go to a doctor and ask that you get an HIV test. If you don’t have symptoms but still think you might have come into contact with the virus, get tested.
Early testing is important for two reasons. First, at this stage, levels of HIV in your blood and bodily fluids are very high. This makes it especially contagious. Second, starting treatment as soon as possible might help boost your immune system and ease your symptoms.
A combination of medications (called HIV drugs, antiretroviral therapy, or ART) can help fight HIV, keep your immune system healthy, and keep you from spreading the virus. If you take these medications and have healthy habits, your HIV infection probably won’t get worse.
Second Stage: Clinical Latency Symptoms
After your immune system loses the battle with HIV, the flu-like symptoms will go away. But there’s a lot going on inside your body. Doctors call this the asymptomatic period or chronic HIV infection.
In your body, cells called CD4 T cells coordinate your immune system’s response. During this stage, untreated HIV will kill CD4 cells and destroy your immune system. Your doctor can check how many of these cells you have with blood tests. Without treatment, the number of CD4 cells will drop, and you’ll be more likely to get other infections.
Most people don’t have symptoms they can see or feel. You may not realize that you’re infected and can pass HIV on to others.
If you’re taking ART, you might stay in this phase for decades. You can pass the virus on to other people, but it’s extremely rare if you take your medicines.
Third Stage: AIDS Symptoms
AIDS is the advanced stage of HIV infection. This is usually when your CD4 T-cell number drops below 200 and your immune system is badly damaged. You might get an opportunistic infection, an illness that happens more often and is worse in people who have weakened immune systems. Some of these, such as Kaposi’s sarcoma (a form of skin cancer) and pneumocystis pneumonia (a lung disease), are also considered “AIDS-defining illnesses.”
If you didn’t know earlier that you were infected with HIV, you may realize it after you have some of these symptoms:
- Being tired all the time
- Swollen lymph nodes in your neck or groin
- Fever that lasts more than 10 days
- Night sweats
- Weight loss with no obvious reason
- Purplish spots on your skin that don’t go away
- Shortness of breath
- Severe, long-lasting diarrhea
- Yeast infections in your mouth, throat, or vagina
- Bruises or bleeding you can’t explain
- Neurological symptoms such as memory loss, confusion, balance problems, behavior changes, seizures, and vision changes
People with AIDS who don’t take medication live about 3 years, or less if they get another infection. But HIV can still be treated at this stage. If you start on HIV drugs, stay on them, follow your doctor’s advice, and keep healthy habits, you can live a long time.
Show Sources
World Health Organization: “HIV Infection.”
CDC: “HIV/AIDS,” “About HIV/AIDS,” “AIDS and Opportunistic Infections.”
AIDS.gov: “Stage of HIV Infection.”
Betts, R. A Practical Approach to Infectious Diseases, Lippincott Williams & Wilkins, fifth edition, 2005.
Heymann, D. Control of Communicable Diseases Manual, 18th edition.
American Public Health Association, Washington, D.C., 2004.
Lashley, F. Emerging Infectious Diseases: Trends and Issues, Springer Publishing, 2004.
HIV.gov: “Symptoms of HIV.”
UpToDate: “Patient education: HIV/AIDS (Beyond The Basics),” “Acute and early HIV infection: Treatment.”
Mayo Clinic: “HIV/AIDS.”
U.S. National Library of Medicine: “HIV and Opportunistic Infections, Coinfections, and Conditions,” “CD4 T Lymphocyte.”
UCSF Health: “HIV Signs and Symptoms,” “AIDS Signs and Symptoms.”
HIV1 and HIV2: 69 Symptoms, Risk and Their Differences
HIV-1 is the most common and pathogenic strain of the virus. Scientists divide HIV-1 into a major group (Group M) and two or more minor groups, namely Group N, O and possibly a group P. Each group is believed to represent an independent transmission of SIV into humans (but subtypes within a group are not). A total of 39 ORFs are found in all six possible reading frames (RFs) of HIV-1 complete genome sequence, but only a few of them are functional.
Symptoms of HIV-1
HIV may not cause symptoms early on. People who do have symptoms may mistake them for the flu or mono. Common early symptoms include:
- Fever.
- Sore throat.
- Headache.
- Muscle aches and joint pain.
- Swollen glands (swollen lymph nodes).
- Skin rash.
Symptoms may appear from a few days to several weeks after a person is first infected. The early symptoms usually go away within 2 to 3 weeks.
After the early symptoms go away, an infected person may not have symptoms again for many years. After a certain point, symptoms reappear and then remain. These symptoms usually include:
- Swollen lymph nodes.
- Extreme tiredness.
- Weight loss.
- Fever.
- Night sweats.
Who is at Risk for HIV1?
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 education: 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
What is HIV2?
HIV-1 and HIV-2 are distinct retroviruses originating from two different primate species.1 Transmission modes for both strains are the same, and infection with either strain can lead to the development of AIDS.
The origin of HIV-2 is attributed to the sooty mangabey monkey. There are at least eight identified subtypes of HIV-2, but only subtypes A and B are commonly found. Although the majority of HIV-2 infections have been found in West Africa, the number of diagnosed cases in India is increasing. HIV-2 cases are also found in European countries with former colonial ties (particularly Portugal and France) to West Africa. Incidence of HIV-2 infection remains low in the UK (144 HIV-2 mono-infections and 22 HIV-1 and 2 dual infections).
Symptoms of HIV-2
The list of signs and symptoms mentioned in various sources for HIV-2 includes the 69 symptoms listed below:
- Some people may be asymptomatic for many years.
- Extreme fatigue
- Rash – early symptom
- Flu-like symptoms – early symptom
- Early symptom
- Chills
- Weakness
- Weakened immune system
- Low CD4+ count
- Persistently swollen lymph nodes
- Persistently tender lymph nodes
- Rapid weight loss
- Persistent diarrhea
- Shortness of breath
- Dry cough
- Intermittent fevers
- Night sweats
- Increased incidence of infections and other illnesses
- Purple spots on skin
- Purple spots on mucous membranes
- Confusion
- Diarrhea
- Mouth sores
- Headache
- Stiff muscles
- Sore muscles
- Forgetfulness
- Reduced mental functioning
- Susceptibility to opportunistic infection
- Susceptibility to opportunistic bacterial infections
- Susceptibility to opportunistic Mycobacterial infections
- Susceptibility to opportunistic fungal infections
- Susceptibility to AIDS-related cancers
- Susceptibility to opportunistic protozoal infections
- Susceptibility to opportunistic viral infections
- Positive HIV test result
- Increased susceptibility to Mycobacteriu avium complex (MAC)
- Increased susceptibility to Salmonellosis
- Increased susceptibility to Syphilis
- Increased susceptibility to Neurosyphilis
- Increased susceptibility to Tuberculosis
- Increased susceptibility to Bacillary angiomatosis
- Increased susceptibility to Aspergillosis
- Increased susceptibility to Candidiasis
- Increased susceptibility to Coccidioidomycosis
- Increased susceptibility to Cryptococcal meningitis
- Increased susceptibility to Histoplasmosis
- Increased susceptibility to Kaposi’s sarcoma
- Increased susceptibility to Non-Hodgkin’s lymphoma
- Increased susceptibility to Primary central nervous system lymphoma
- Increased susceptibility to Invasive cervical cancer
- Increased susceptibility to Cryptosporidiosis
- Increased susceptibility to Isosporiasis
- Increased susceptibility to Microsporidiosis
- Increased susceptibility to Toxoplasmosis
- Increased susceptibility to Pneumocystis carinii pneumonia
- Increased susceptibility to Cytomegalovirus
- Increased susceptibility to Hepatitis
- Increased susceptibility to Herpes simplex
- Increased susceptibility to Herpes zoster
- Increased susceptibility to Human papillomavirus
- Increased susceptibility to Molluscum contagiosum
- Increased susceptibility to Oral hairy leukoplaia
- Increased susceptibility to aphthous ulcers
- Increased susceptibility to idiopathic thrombocytopenia purpura
- Increased susceptibility to listerosis
- Increased susceptibility to pelvic inflammatory disease
- Increased susceptibility to Burkitt’s lymphoma
- Increased susceptibility to immunoblastic lymphoma
Difference Between HIV1 and HIV2
| HIV-1 | HIV-2 |
|---|---|
| This strain is found worldwide and is more common. | This strain is found predominantly in West Africa. |
| This strain is more likely to progress and worsen. | This strain is less likely to progress and many of those infected remain lifelong non-progressors. Progression is slower. |
| Average level of immune system activation are higher. | Average level of immune system activation are lower. |
| During progression, HIV-1 has lower CD4 counts than HIV-2. | During progression, CD4 counts are higher in this strain. |
| Plasma viral loads are higher. | Plasma viral loads are lower. |
A Timeline of HIV Symptoms
Some symptoms appear during the first few weeks of infection, whereas others can surface years later.
By James Myhre Medically Reviewed by Laura J Martin, MD
Reviewed: December 9, 2021
The signs and symptoms of an HIV infection (from the human immunodeficiency virus) can vary from person to person — and many people won’t know they’ve been infected until years after they were first exposed to the virus.
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:
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7 to 14 Days After Exposure
Known as acute retroviral syndrome, or ARS, the acute stage occurs immediately after being infected, when the immune system has yet to control the virus. During this time, an estimated 40 percent to 90 percent of people will experience mild to moderate flu-like symptoms, whereas the rest won’t experience any symptoms at all.
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:
- Fever
- Fatigue
- Headache
- Sore throat
- Muscle aches
- Joint pain
- Swollen lymph nodes
- Night sweats
- Nausea
- Diarrhea
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 mouth
- Unexplained fevers and drenching night sweats that soak through bedsheets and nightclothes
- Severe, 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)
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