Signs and symptoms of HIV

Signs and symptoms of HIV

Symptoms of HIV infection

The human immunodeficiency virus is a retrovirus (Retroviridae family) that contains RNA and affects the immune system by attacking CD4+ T-lymphocytes, macrophages and dendritic cells. HIV attaches to the CD 4+ receptors expressed on the surface of these cells and enters their nucleus where with the help of the enzyme reverse transcriptase synthesizes DNA and replicates. Occurs viremia and the HIV spreads throughout the body.

There are two types of HIV distinguished – HIV-1 and HIV-2. HIV-1 is more common, whereas HIV-2 is mainly found in West Africa.

WHO Clinical Staging of HIV/AIDS for Adults and Adolescents

symptoms of HIVPrimary HIV Infection

  • Asymptomatic
  • Acute retroviral syndrome

Clinical Stage 1

  • Asymptomatic
  • Persistent generalized lymphadenopathy

Clinical Stage 2

  • Moderate unexplained weight loss (<10% of presumed or measured body weight)
  • Recurrent respiratory infections (sinusitis, tonsillitis, otitis media, and pharyngitis)
  • Herpes zoster
  • Angular cheilitis
  • Recurrent oral ulceration
  • Papular pruritic eruptions
  • Seborrheic dermatitis
  • Fungal nail infections

Clinical Stage 3

  • Unexplained severe weight loss (>10% of presumed or measured body weight)
  • Unexplained chronic diarrhea for >1 month
  • Unexplained persistent fever for >1 month (>37.6°C, intermittent or constant)
  • Persistent oral candidiasis (thrush)
  • Oral hairy leukoplakia
  • Pulmonary tuberculosis (current)
  • Severe presumed bacterial infections (e.g., pneumonia, empyema, pyomyositis, bone or joint infection, meningitis, bacteremia)
  • Acute necrotizing ulcerative stomatitis, gingivitis, or periodontitis
  • Unexplained anemia (hemoglobin <8 g/dL)
  • Neutropenia (neutrophils <500 cells/µL)
  • Chronic thrombocytopenia (platelets <50,000 cells/µL)

Clinical Stage 4

  • HIV wasting syndrome (according to CDC)
  • Pneumocystis pneumonia
  • Recurrent severe bacterial pneumonia
  • Chronic herpes simplex infection (orolabial, genital, or anorectal site for >1 month or visceral herpes at any site)
  • Esophageal candidiasis (or candidiasis of trachea, bronchi, or lungs)
  • Extrapulmonary tuberculosis
  • Kaposi sarcoma
  • Cytomegalovirus infection (retinitis or infection of other organs)
  • Central nervous system toxoplasmosis
  • HIV encephalopathy
  • Cryptococcosis, extrapulmonary (including meningitis)
  • Disseminated nontuberculosis mycobacteria infection
  • Progressive multifocal leukoencephalopathy
  • Candida of the trachea, bronchi, or lungs
  • Chronic cryptosporidiosis (with diarrhea)
  • Chronic isosporiasis
  • Disseminated mycosis (e.g., histoplasmosis, coccidioidomycosis, penicilliosis)
  • Recurrent nontyphoidal Salmonella bacteremia
  • Lymphoma (cerebral or B-cell non-Hodgkin)
  • Invasive cervical carcinoma
  • Atypical disseminated leishmaniasis
  • Symptomatic HIV-associated nephropathy
  • Symptomatic HIV-associated cardiomyopathy
  • Reactivation of American trypanosomiasis (meningoencephalitis or myocarditis)

HIV test

Primary HIV infection (Acute HIV infection)

Within 2 to 4 weeks after the HIV contraction develops the condition known as an acute HIV infection.

Acute retroviral syndrome is characterized by the various non-specific symptoms.

Flu-like/mononucleosis-like symptoms of acute HIV infection include:

  • Fatigue and general malaise;
  • Headache;
  • Muscle pain (myalgia);
  • Sore throat;
  • Joint pain;
  • Lymphadenopathy (enlargement of the lymph nodes);
  • Night sweats;
  • Increased body temperature, fever and chills;
  • Unexplained weight loss;
  • Maculopapular rash;
  • Enlargement of the spleen and liver;
  • Nausea and vomiting;
  • Diarrhea;
  • Loss of appetite;

These symptoms may last for a few days or up to four weeks.

Chronic HIV infection

For many years (even up to 15 years) HIV infection may remain asymptomatic so an infected person continues to spread the virus without knowing it. The duration of this stage depends on the age of the person and her/his health prior to the infection.


The advanced stage of HIV infection is known as AIDS – acquired immunodeficiency syndrome. A person experiences chronic diarrhea, night sweats, fever, persistent cough, and loses weight without any obvious reason. The characteristic feature of AIDS is the development of opportunistic infections. Sometimes the diagnosis is made only when any of opportunistic infections is detected. These infections are not common for healthy individuals with unaffected immune system.

Such infections include candidiasis, tuberculosis, Kaposi’s sarcoma, cytomegalovirus infection, herpes zoster, histiocytosis, atypical pneumonia and many others.

Respectively, the symptoms of AIDS may be various:

  • Unexplained weight loss;
  • Anorexia;
  • Abdominal pain, diarrhea, nausea and vomiting;
  • Skin rash;
  • Skin and mucous membranes ulcers;
  • White plaques on the skin and mucous membranes;
  • Cough and shortness of breath;
  • Enlarged lymph nodes;
  • Night sweats;
  • Fever and chills;
  • Enlarged liver and spleen;
  • Headaches;
  • Dementia and behavioral changes;
  • Neurologic deficits – muscle weakness or impaired sensations;
  • Vision loss;
  • General malaise;
  • Fatigue;

HIV wasting syndrome

HIV wasting syndrome is diagnosed when a person loses weight progressively (more than 10% of initial body weight), he/she experiences fever, weakness and diarrhea. The nutrition, absorption of nutrients and metabolism are impaired. As a result cachexia occurs – explicit exhaustion of the body.