Signs and Symptoms of HIV Infection

HIV infection is typically described in phases during which certain symptoms are more likely to develop. As with the course of the disease itself, the symptoms are not the same for all people. Some symptoms may develop earlier or later than others or not at all.

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

Some of the symptoms may be the direct result of HIV infection while others, particularly those in the latter stages, are caused when the destruction of the immune system leaves the body vulnerable to opportunistic infections.

In some of the earlier stages of infection, a person may, in fact, be entirely asymptomatic (without symptoms) even though the immune system is being progressively damaged. When the immune defenses are fully compromised, some of the most serious and potentially life-threatening opportunistic infections can occur.

Symptoms of Acute HIV Infection

Verywell / Colleen Tighe

HIV is not equal in the population of people it affects. Because fewer Black people with HIV receive HIV-specific care compared to the people living with HIV in general (63% vs. 66%), fewer are able to achieve complete viral suppression while on treatment (51% vs. 57%). This leaves Black people at greater risk of developing opportunistic infections and dying.

HIV Among Black People in the US

Black people with HIV in the United States have an eight-fold greater risk of death compared to Whites with HIV (19,8 per 100,000 vs. 2.9 per 100,000). And this, despite the fact that Blacks are no less likely to be diagnosed during late-stage infection than Whites.

Stage 1: Primary Infection (Acute HIV)

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

In fighting the virus, the immune system will release chemicals that trigger a whole-body inflammatory response. This can lead to flu-like symptoms in two of every three newly infected people, usually within two to four weeks.

Symptoms of acute HIV infection include:

One in five people may also develop an "HIV rash" with 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 of the mouth and genitals.

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

HIV Among Black MSM

Signs of acute HIV are the same for all people, no matter their race or sex. With that said, Black people and men who have sex with men (MSM) account for the lion's share of new infections. Today, roughly 30% of all new infections are among Black MSM who have no less than a 50/50 chance of getting HIV in their lifetime.

Stage 2: Clinical Latency (Chronic HIV)

Stage 2 is the phase in which the acute symptoms have largely resolved, and the virus will persist but be far less active. Although lymphadenopathy (swollen lymph nodes) may persist for months following the initial infection, this stage of the disease is largely asymptomatic.

Also known as clinical latency or chronic HIV infection, stage 2 is characterized by the gradual destruction of immune cells, called CD4 T cells, and the gradual increase in the number of viruses in the body, as measured by the viral load. The Centers for Disease Control and Prevention (CDC) broadly defines the chronic stage of HIV as a CD4 count of between 499 and 200.

Without treatment, the chronic phase can last for around 10 years during which there may be few notable symptoms. But, as the CD4 count continues to drop, an ever-widening range of opportunistic infections can develop, both common and uncommon.

During this stage, the symptoms, if any, are generally related to these infections, which can include:

Disease 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, social factors like poverty and the lack of access to healthcare also play a role.

Studies suggest that low socioeconomic status is associated is poorer immune status in people with HIV as measured by the CD4 count. A low CD4 count at the time of diagnosis is, in turn, associated with a faster disease progression.

HIV and Poverty in People of Color

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 of infection where the immune system has been compromised and unable to defend itself against an ever-expanding array of serious opportunistic infections. 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 advanced HIV infection and are rarely seen in people with intact immune systems. Some like tuberculosis can occur at CD4 counts well count 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 from occurring. This includes starting antiretroviral therapy if you haven't already done so and, if needed, taking disease-specific prophylactic (preventive) drugs.

Symptoms at this stage are primarily related to the opportunistic infection, although some, like AIDS dementia, are due to the consequence of long-term untreated infection. Others are only considered AIDS-defining if they recur, are disseminated (widely dispersed), or are invasive (spread beyond their original site).

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

AIDS Diagnoses Among Black People

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

A Word From Verywell

Knowing the symptoms of HIV can help you seek timely diagnosis and treatment. But, symptoms alone should not be the reason for you to get a test.

If you suspect that you've been exposed to HIV, either now or anytime in the past, see your healthcare provider and ask to be tested. Because there are treatments today that can help you live a long, healthy life, the CDC recommends HIV testing at least once for everyone ages 13 to 64 as part of routine medical care.

By doing so, you not only protect your long-term health but others around you.

Frequently Asked Questions

  • Can HIV symptoms differ by gender?

    Yes. Women may experience repeat vaginal yeast infections, pelvic inflammatory disease, irregular menstrual cycles, higher risks of cervical cancer and osteoporosis, and earlier menopause than women who do not have HIV. Women 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 handled or labeled incorrectly, specimens are mixed up, results are misread, or autoimmune disorders or other medical conditions affect the test result.

  • How do you contract HIV?

    HIV is usually spread through sexual contact, sharing drug needles, or from mother to baby during pregnancy, childbirth, or nursing.

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17 Sources
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