What Are the Early Signs of HIV?

Identifying the Signs Can Better Help Ensure Early Care and Treatment

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Question: What are the early signs of an HIV infection?

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

However, in 40% of cases, flu-like symptoms will develop within seven to 14 days of an exposure.

This condition is commonly referred to as acute retroviral syndrome, or ARS (alternately known as acute seroconversion syndrome or seroconversion illness).

ARS can often present with the following 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 (commonly 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% will likely experience short-term nausea, diarrhea or vomiting.

Most of these symptoms are a direct result of the body’s immune response as HIV rapidly disseminates from the site of infection to lymphoid tissues, triggering an inflammatory response.

ARS can persist for up to four months until such time as the immune system begins to take control of viral replication.

While HIV will still replicating during this later, chronic stage of infection, it generally does so at a slower level until the HIV viral load is stabilized and a so-called "viral set point" is established.

Confirming an HIV Infection

A diagnosis of ARS can often be missed because the symptomatology is so flu-like in its presentation.

It is, therefore, important to

  • Understand how HIV is transmitted
  • Be cognizant of any possible exposure that might have occurred, regardless of whether symptoms develop or not
  • Recognize the possible signs of an acute HIV infection, and
  • Get an HIV test should you suspect you have been infected.

Since an HIV test can often deliver a negative or indeterminate serostatus during the early stage of infection, an HIV viral load test can be used if the symptomatology is suggestive of an ARS diagnosis. If the patient has a negative or indeterminate antibody result but a high viral load (over 100,000 copies/mL), they can be considered to be infected (although an antibody test should be repeated at a later date to confirm seroconversion). 

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

In May 2013, the U.S. Preventive Services Task Force issued recommendations that all Americans age 15-65 get tested for HIV as part of a routine doctor visit.

Others who 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.

Ultimately, early treatment prevents the depletion of CD4 cells, central to the immune response. Mounting evidence also suggest that early intervention (within 10-12 weeks of infection) may result in a reduction in the latent viral reservoirs, where HIV can persist even in the face of successful antiretroviral therapy.

If so, this may provide an HIV-infected person with better viral control and reduce the risk of non-HIV-associated illnesses commonly seen in people with long term infection. It can also reduce the risk of passing the virus to an uninfected partner, a strategy popularly referred to as Treatment as Protection (or TasP).

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


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.

Hogg, R.; Althoff, K.; Samji, H.; et al. "Increases in life expectancy among treated HIV-positive individuals in the United States and Canada, 2000-2007." 7th International AIDS Society (IAS) Conference on Pathogenesis, Treatment and Prevention. Kuala Lumpur, Malaysia. June 30-July 3, 2013; Abstract TUPE260.

Moyer, V. "Screening for HIV: U.S. Preventive Services Task Force Recommendation Statement." April 30, 2013. Annals of Internal Medicine. April 30, 2013; doi:10.7326/0003-4819-159-1-201307020-00645.

Heinrich, T. and Gandhi, R. "Early Treatment and HIV Reservoirs: A Stitch in Time?" The Journal of Infectious Diseases. July 2013; doi: 10.1093/infdis/jit307.

Department of Health and Human Services (DHHS). "Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents." Accessed January 2, 2014.

The INSIGHT START Study Group. "Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection." New England Journal of Medicine. July 20, 2015; DOI: 10.1056/NEJMoa1506816.

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