HIV and AIDS Symptoms by Stage

What to expect and how to manage symptoms as HIV progresses

This article is part of Health Divide: HIV, a destination in our Health Divide series.

HIV progresses in stages during which different illnesses and symptoms can develop.

HIV is a virus that causes immunodeficiency (the loss of immune function). It progressively kills disease-fighting white blood cells, called CD4 T-cells, leaving the body vulnerable to an ever-widening range of opportunistic infections (OIs). The types of OIs a person can get corresponds to how much the immune system has been destroyed.

The three stages of HIV infection are:

This article describes the possible signs and symptoms of HIV at the different stages of infection. It also explains why different population groups are more likely to experience symptoms of AIDS than others.

Symptoms of Acute HIV

Verywell / Colleen Tighe

HIV Among Black People in the U.S.

HIV disproportionately affects people of color in the United States. Because they are less likely to receive HIV-specific care, Black people with HIV are at an eight-fold greater risk of death than White people with HIV. This, despite the fact that Black people are no less likely to be diagnosed during later-stage infection than White people.

Stage 1: Primary Exposure (Acute HIV)

Stage 1 is the phase when HIV enters the body and causes flu-like symptoms as the immune system launches its frontline defense. Also known as acute HIV, primary HIV, acute seroconversion, or acute retroviral syndrome, stage 1 is characterized by the body's efforts to bring HIV under control.

In fighting the virus, the immune system will release chemicals that trigger whole-body inflammation. This can lead to flu-like symptoms in two of every three cases, usually within two to four weeks of exposure to the virus.

Early symptoms of HIV include:

One in five people may also develop an "HIV rash." The rash will usually involve raised, reddened areas of skin covered with small, pimple-like bumps. The rash will often affect the upper body and may be accompanied by ulcers in the mouth and on the genitals.

The acute stage can last for around two to four weeks, after which symptoms will spontaneously clear as the body brings the infection under control. The virus is not gone but instead moves into the next phase known as clinical latency.

HIV Among Black MSM and Trans People

Black people and men who have sex with men (MSM) account for the lion's share of new HIV infections in the United States. Roughly 30% of all new cases are among Black MSM who have no less than a 50/50 chance of getting HIV in their lifetime. Black transgender people are also at risk, particularly Black trans women of whom 62% are living with HIV.

Causes for this disparity include stigma, racism, higher rates of poverty, lack of access to quality healthcare, and distrust in public health institutions.

Stage 2: Clinical Latency (Chronic HIV)

Stage 2 is when the acute HIV symptoms have cleared, but the infection persists "silently" at lower levels. The infection is no longer considered acute (meaning severe and sudden) but is now regarded as chronic (meaning persistent).

During this prolonged stage, many people do not realize that they've been infected and will end up passing the virus to others. There may be certain non-specific signs during this stage, such as swollen lymph nodes (lymphadenopathy), but these also tend to clear within several months.

Even though the infection is largely "silent," the virus will continue to deplete CD4 T-cells, which normally run between 500 and 1,500 cells per cubic milliliter (cells/mm3) of blood in people without HIV.

During clinical latency, the loss of CD4 T-cells causes immunodeficiency, meaning that the body has lost the immune defenses that normally protect against diseases. The Centers for Disease Control and Prevention (CDC) defines this as a CD4 count between 499 and 200 cells/mm3.

Without treatment, the chronic phase of HIV can last for around 10 years, during which there may be few notable symptoms.

As the CD4 count continues to drop, an ever-widening range of OIs can develop, both common and uncommon.

These include:

Even so, people will often fail to connect these conditions to HIV simply because they can occur in the absence of HIV.

Low CD4 Count

Verywell / Julie Bang

HIV Progression

The progression of HIV is not the same for all people. For some, the period of clinical latency may only last for two years. Although there are many reasons for this, including a person's genetics and the type of HIV they have, social factors like poverty and the lack of insurance also play a part.

Studies have shown that low socioeconomic status is associated with poorer immune status in people with HIV (as measured by the CD4 count). A low CD4 count at the time of exposure is, in turn, associated with faster disease progression.

HIV and Poverty in Black and Latinx Communities

According to the CDC, the rate of poverty among people living with HIV in urban Latinx and Black communities is four and 19 times greater, respectively, than their White counterparts. This translates to faster disease progression and poorer survival times in people of color.

Stage 3: Symptomatic HIV (AIDS)

Stage 3 is the phase where the immune system has been fully compromised. This leads to serious OIs with a wide range of symptoms.

Also known as AIDS (acquired immune deficiency syndrome), stage 3 is defined by the CDC as having a CD4 count under 200 or the presence of an AIDS-defining condition.

AIDS-defining conditions are those that occur in the setting of HIV that are rarely seen in people with intact immune systems. Some infections, like tuberculosis, can occur at CD4 counts well over 200, but most occur when the CD4 count drops below 200.

On the flip side, it is possible to have a CD4 under 200 and no AIDS-defining condition. Even so, aggressive steps will be taken to prevent them. This includes starting antiretroviral therapy if you haven't already done so and taking preventive drugs called prophylactics if needed.

Symptoms at this stage are primarily related to the OI a person develops (although some, like AIDS dementia, are the result of long-term harm caused by HIV). Others are only considered AIDS-defining if they recur, are disseminated (dispersed), or are invasive (spread beyond their original site).

ART is recommended for all patients with HIV regardless of CD4 count and that ART as early as possible during the course of infection can prevent progression. CD4 loss is not inevitable and can be prevented or halted via the initiation of ART.

There are 27 conditions classified as AIDS-defining by the CDC:

Possible Symptoms of AIDS by Organ System
Organ System Possible Symptoms
Brain - Painful headaches
- Muscle weakness
- Numbness or nerve pain
- Loss of coordination and clumsiness
- Difficulty walking
- Hearing impairment
- Changes in vision
- Difficulty swallowing
- Confusion
- Changes in behavior
- Seizures
- Dementia
Eyes - Persistent dye dryness
- Decreased vision
- Extreme sensitivity to light
- Matting or whitening of the cornea
- Vision loss
- Blindness
Gastrointestinal - Mouth and throat sores
- Whitish growth in the mouth or throat
- Severe abdominal pain
- Lower abdominal swelling
- Bloating and gas
- Difficulty swallowing
- Painful swallowing
- Nausea and vomiting
- Diarrhea
- Constipation
- Blood in stool
- Bloody vomit
- Black or tarry stools
- Rectal pain
- Unintended weight loss
Liver - Upper abdominal pain
- Extreme fatigue
- Loss of appetite
- Nausea and vomiting
- Clay-colored stools
- Dark cola-colored urine
- Ascites (fluid buildup in the abdomen)
- Jaundice (yellowing of eyes and skin)
Lungs - Shortness of breath
- Wheezing
- Chronic cough
- Phlegm
- Difficulty breathing
- Chest pain
- Easy exhaustion with physical activity
- Crackling lung sounds
- Pneumonia
Skin - Painless bruise-like lesions
- Outbreak of painful blisters and ulcers
- Whole-body rash
- Hardened or crusty skin plaques
- Pus-filled skin eruptions
- Nail deformity
- Cellulitis and other skin infections

AIDS Diagnoses Among Black People

Due to health inequities and other vulnerabilities, Black people with HIV are more than 10 times more likely to progress to AIDS than White people with HIV and three times more likely than Latinx people with HIV.

Frequently Asked Questions

  • Can HIV symptoms differ by sex?

    Yes. People assigned female at birth may experience repeat vaginal yeast infections, pelvic inflammatory disease, irregular menstrual cycles, higher risks of cervical cancer and osteoporosis, and earlier menopause than those who do not have HIV. People assigned female at birth may also have more severe side effects from HIV medication and drug interactions between birth control and HIV medication.

  • Can you receive a false-positive HIV test result?

    Yes, false-positive HIV test results can occur, but they are very rare. Sometimes, false positives occur if the test is mishandled or mislabeled, specimens are mixed up, or results are misread. Autoimmune disorders or other medical conditions can also affect the test results.

  • How do you acquire HIV?

    HIV is usually transmitted through sexual contact, sharing drug needles, or from birthing parent to baby during pregnancy, childbirth, or nursing.

18 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  13. Centers for Disease Control and Prevention. Economically disadvantaged.

  14. Kaiser Family Foundation. AIDS diagnoses, adults and adolescents, by race/ethnicity.

  15. Centers for Disease Control and Prevention. Appendix A: AIDS-defining conditions.

  16. MedlinePlus. HIV/AIDS in women.

  17. Centers for Disease Control and Prevention. False-positive HIV test results.

  18. Centers for Disease Control and Prevention. Ways HIV can be transmitted.

Additional Reading

By James Myhre & Dennis Sifris, MD
Dennis Sifris, MD, is an HIV specialist and Medical Director of LifeSense Disease Management. James Myhre is an American journalist and HIV educator.