Early Signs and Symptoms of HIV

In the early stages of infection, many people will develop little or no signs of illness. This is, perhaps, one of the reasons why 20 percent of the 1.2 million Americans living with HIV go undiagnosed. They either don't realize they've been infected or will only act when outward signs begin to appear.

However, as many as 40 percent of cases, flu-like symptoms will develop within 7 to 14 days of exposure. This condition is commonly referred to as acute retroviral syndrome (also referred to as ARS, acute seroconversion syndrome, or seroconversion illness).

Acute Symptoms

Acute retroviral syndrome (ARS) symptoms
Verywell / Nusha Ashjaee

ARS can often present with the following acute symptoms, ranging from mild to severe:

  • Fever
  • Fatigue
  • Headache
  • Pharyngitis (sore throat)
  • Myalgia (muscular aches and pain)
  • Arthralgia (joint pain)
  • Lymphadenopathy (swollen lymph glands)

Occasionally, these symptoms will be accompanied by a rash (popularly referred to as an HIV rash) which manifests with pink-to-red bumps that converge into larger patches, primarily on the upper half of the body. Moreover, 30 percent of people will experience short-term nausea, diarrhea, or vomiting.

Most of these symptoms are a result of the body’s response to HIV as it rapidly spreads from the site of infection to lymph tissue, triggering an inflammatory response.

ARS can persist for months until the immune system is finally able to take control of the virus. This is followed by the chronic stage of infection in which the virus slowly dismantles the immune defense over months and years.

While HIV will still be replicating at this stage, it generally does so at a slower rate until the viral load finally levels off and established a so-called "viral set point."

Confirming Infection

ARS can be missed even by a doctor because the symptoms are often so flu-like in their presentation. It is, therefore, important to understand how HIV is transmitted; to recognize the acute symptoms of HIV, and to get an HIV test should you suspect you have been infected.

Since an HIV test can often deliver a negative or indeterminate result during the early stages of infection, an HIV viral load test can be used if symptoms are suggestive of ARS.

In such instances, if the person has a negative or indeterminate antibody result but a high viral load (over 100,000 copies/mL), he or she would be considered HIV-positive. Treatment would ideally begin immediately, while a follow-up test would be performed at a later date to confirm the results.

Newer combination antibody/antigen assays have also proven highly effective in confirming serostatus during ARS, with some of the test displaying extremely high levels of accuracy.

The U.S. Preventive Services Task Force currently recommends the once-off testing of all Americans 15 to 65 as part of a routine doctor visit.

Other people at higher risk for infection—including sexually active men who have sex with men (MSM)—should be tested annually.

Benefits of Early Detection

Recognizing the symptoms of ARS is important as it affords a person the opportunity for early detection. This not only helps ensure that HIV is not spread to others but offers benefits in the way of early treatment.

Studies indicate that the early initiation of antiretroviral therapy correlates to a reduced risk of both HIV-related and AIDS-defining illnesses. By contrast, delaying therapy until a person’s CD4 count drops below 350 cells/mL is associated with not only more adverse clinical events, but a significant—and even profound—reduction in life years.

Early treatment prevents often-irreversible damage to the immune system. It also reduces the risk of passing the virus to others, a strategy known as treatment as protection (TasP).

It is now recommended that HIV therapy be started at the time of diagnosis, the practice of which is known to reduce the likelihood of illness and death by 57 percent.

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Article Sources

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  • Rodger, A.; Cambiano, V.; Bruun, T. et al. Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. Lancet. 2019 May 2; pii: S0140-6736(19)30418-0. doi:10.1016/S0140-6736(19)30418-0.