HIV and AIDS

Common HIV Signs and Symptoms

An Overview of HIV/AIDS Symptoms

The course of HIV varies from person to person as do the signs and symptoms of infection. In many cases, HIV will not present with any notable symptoms for years, and even decades, at a time. It is often only when the disease progresses—gradually depleting immune function as it kills off defensive CD4 T-cells—that the signs of HIV become fully apparent. Unfortunately, this is also the stage when the disease is more advanced and often more difficult to treat.

Knowing the signs of HIV infection are important in directing you to timely testing, care, and treatment. But they alone should not be the reason for you to get a test.  If you suspect that you have been exposed to HIV, either now or anytime in the past, do not wait for the signs to appear. Get tested now. It is the only way to know for sure if you have HIV. By doing so, you can better ensure not only your long-term health  but the health of those around you.

Acute vs. Chronic Symptoms

The stages of HIV are typically defined as being either acute or chronic. This is important to understand because the types of symptoms one can experience may not only suggest that a person has been infected—it can also indicate how recent or advanced an infection may be.

  • An acute HIV infection refers to the period when the body first reacts to the presence of the virus and spurs an immune defense. During this time, about 40 percent of people will experience flu-like symptoms as the body fights to control the infection. While some of the signs may be generalized and non-specific, there may be others more suggestive of an acute infection—particularly if there has been a recent risk of exposure.
  • A chronic HIV infection, by contrast, refers to the period after which the acute symptoms have resolved. To some, the resolution of symptoms (or lack of symptoms) may serve as proof that an infection has been avoided. But the simple fact is that many of the signs of chronic HIV are invisible and may remain so for years at a time as the virus silently depletes immune defense. It is often only when the defenses are breached that the first signs of illness appear, accompanied by a slew of symptoms more indicative of a long-term infection than an acute one.

Top 6 Signs of HIV

These can be classified as those commonly seen during either the acute or chronic stage of infection (and occasionally both):

  1. An Unexplained Rash. A rash is often the first sign of an acute infection, although it only appears in two out of every five newly infection individuals. Often referred to as an "HIV rash," it has a specific appearance that clinicians typically described as being maculopapular. By definition, a maculopapular rash is one characterized by raised, pink-to-red areas of skin that are covered with small, pimple-like bumps that often merge together into one.

    While many diseases can cause this type of rash, during an acute HIV infection the rash will generally affect the upper parts of the body, sometimes accompanied by ulcers on the mucous membranes of the mouth or genitals. Flu-like symptoms are also common. Outbreaks usually resolve in between one to two weeks. HIV therapy should be commenced once an infection has been confirmed.

  1. Swollen Lymph Glands. Swollen lymph glands (also known as lymphadenopathy) are often present in the acute stage of HIV. Frequently appearing on the neck, below or behind the ear, in the groin, or under the armpit, lymphadenopathy can not only be painful but unsightly in more severe cases. People are sometimes confused by lymphadenopathy, believing it to be a sign of an "infected" lymph node. If anything, it is more an indication of a robust immune response as the body aims to fight off an infective agent like HIV.

    Lymphadenopathy during the acute stage is frequently generalized, meaning that it occurs in two or more sites in the body. When the nodes are larger than two centimeters (approximately an inch) and last for more than three months, it is typically referred to as persistent generalized lymphadenopathy, or PGL. PGL can continue well into the chronic stage of infection and may take months, or even years, to fully resolve. The implementation of antiretroviral therapy generally helps resolve the condition by reducing some of the low-level inflammation associated with chronic infection.

  1. Oral Thrush.  We have all had morning mouth—that pasty, bad tasting yuck that coats your mouth each morning when you wake. But what if the bad taste and white coating don't go away with a simple brushing? Then you may have the most common sign of HIV infection—thrush. Also known as candidiasis, thrush is a fungal infection associated with a weakened immune system and can often be the first sign of an approaching illness. While it is commonly seen in the mouth, candidiasis can also present in the throat and vagina.
     
    While candidiasis can occur as a result of any number of non-HIV-related conditions, it is far more common in people with advanced HIV given the progressive nature of immune depletion. As such, we tend to see candidiasis more in people with very low CD4 counts  (under 200 cells/mL). In fact, the prevalence of candidiasis is so high in people with advanced HIV that it's currently classified as an AIDS-defining condition if presenting within the bronchi, trachea, esophagus, or lungs. While antifungal drugs are commonly used to treat thrush, the initiation of HIV therapy can help restore immune function, better reducing the risk of reappearance.

  1. A Sexually Transmitted Disease. Having a sexually transmitted disease (STD) doesn’t necessarily mean that you have HIV, but it certainly does raise the stakes—increasing the susceptibility of an HIV-negative person, as well as the infectivity of an HIV-positive individual. Not only can certain STDs provide HIV with a direct route of entry into the body through open sores and ulcers, they can cause an inflammation which literally draws CD4 cells to the site of infection—ironically, the very cells that HIV targets for infection.

    Studies have also shown that an STD can increase the concentration of HIV in semen and vaginal fluids, elevating the potential for infection even among those on otherwise fully suppressive antiretroviral therapy. As a result, a person co-infected with HIV and an STD is three to five times more likely to infect than a person with HIV alone. Consistent condom use still remains the primary means by which to prevent the spread of HIV and other sexually transmitted infections.

  2. Drenching Night Sweats. We're not talking sweat from the flu or an occasional fever. We're talking unexplained, drenching night sweats that can soak your bed sheets right through. Night sweats (also known as sleep hyperhidrosis) occur frequently in people with HIV, either because of an undiagnosed opportunistic infection or as a direct result of HIV itself. While any number of illnesses can cause night sweats, they are more common in people with advanced HIV infection and manifest with profuse, drenching perspiration with no apparent cause.

    While night sweats themselves are harmless, they can be indicative of a more serious, underlying medical condition. Tuberculosis and other HIV-related diseases (including Mycobacterium avium complex and histoplasmosis) are among the illnesses commonly associated with the condition. Any episode of night sweats should not be ignored and should warrant immediate HIV testing and an overall lab investigation.

  3. Sudden, Severe Weight Loss. Sudden, unexplained weight loss is not uncommon among people with long-term HIV infection—usually in more advanced stages of the disease. However, when it's characterized by weight loss of at least 10 percent and is accompanied by fever and diarrhea for a period of 30 days or more, the condition can be medically classified as HIV wasting.

    Unlike night sweats, HIV wasting has no cause other than HIV itself. And while modern antiretroviral therapy has reduced the incidence of wasting in people with HIV, as many as 34 percent still experience some degree of unexplained weight loss. HIV testing should always be included as part of a medical examination if faced with the sudden, profound loss of weight (and, more specifically, loss of lean muscle mass). In addition to HIV therapy, Fulyzaq (crofelemer), a drug approved by the U.S. Food and Drug Administration, is able to better treat HIV-associated diarrhea. 

Sources:

Cohen, M.; Gay, C.; Busch, P.; and Hecht, F. "The Detection of Acute HIV Infection." The Journal of Infectious Diseases. 2010; 202(Supplement2):S270-S277.

National Institutes of Health (NIH). "Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents." AIDSInfo; Bethesda, Maryland; accessed July 21, 2016. 

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