Patient education: Symptoms of HIV (Beyond the Basics)

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 education: Testing for HIV (Beyond the Basics)".)

WHO IS AT RISK FOR HIV? — HIV is usually acquired through sexual intercourse or exposure to infected blood or body fluids. This may occur:

●During sexual contact with a person with HIV, especially if you have unprotected vaginal or anal sex

●By sharing needles or syringes used by a person with HIV

Transmission from a pregnant person 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, including:

●Men who have sex with men

●People who use injection drugs and share needles or "works"

●Sexual partners of people 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 health care facility

●People who received a blood transfusion or other blood products before 1984

HIV SYMPTOMS

Symptoms of early HIV infection — Early symptoms of HIV 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.

Because the signs and symptoms of primary HIV may be similar to other common illnesses, such as mononucleosis, most people do not initially realize that they have HIV. However, HIV 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 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 — 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 five to eight days.

One characteristic feature of acute HIV 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.

Digestive symptoms — Many people with acute HIV 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, people with HIV can develop infections that are not usually seen in people with normal immunity. These “opportunistic infections” can cause serious disease in patients with advanced HIV. 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 education: 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.

TESTING FOR HIV — HIV testing is the only way to determine if you have 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 if you have HIV and taking precautions can greatly reduce your risk of transmitting the virus to others. (See "Patient education: 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 education: HIV/AIDS (The Basics)
Patient education: Preventing HIV after unprotected sex or needle-sharing (The Basics)
Patient education: Tests to monitor HIV (The Basics)
Patient education: Taking medicines to prevent HIV before exposure (The Basics)
Patient education: Blood or body fluid exposure (The Basics)
Patient education: Sexually transmitted infections (The Basics)
Patient education: Urethritis (The Basics)
Patient education: 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 education: Testing for HIV (Beyond the Basics)
Patient education: Care after sexual assault (Beyond the Basics)
Patient education: 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 patients without HIV
Acute and early HIV infection: Treatment
Acute and early HIV infection: Pathogenesis and epidemiology
Overview of prevention of opportunistic infections in patients with HIV
Screening and diagnostic testing for HIV infection
Techniques and interpretation of measurement of the CD4 cell count in people with HIV
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

(www.cdc.gov)

●CDC 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)

(www.niaid.nih.gov)

●HIV/AIDS Treatment Information Service

Toll-free: (800) 448-0440

(www.clinicalinfo.hiv.gov)

●AIDS Clinical Trials Information Service (ACTIS)

Toll-free: (800) 874-2572

(www.actis.org)

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