Within a month or two
of HIV entering the
body, 40% to 90% of
people experience flu-
like symptoms known as
acute retroviral
syndrome (ARS).
But sometimes HIV symptoms don’t appear for years,
sometimes even a decade, after infection.
“In the early stages of HIV infection, the most
common symptoms are none,” says Michael Horberg,
MD, director of HIV/AIDS for Kaiser Permanente, in
Oakland, Calif. One in five people in the United States
with HIV doesn’t know they have it, which is why it’s
so important to get tested, especially if you have
unprotected sex with more than one partner or use
intravenous drugs.
Here are some signs that you may be HIV-positive.
Fever
One of the first signs of ARS can be a mild fever, up
to about 102 degrees F. The fever, if it occurs at all, is
often accompanied by other usually mild symptoms,
such as fatigue, swollen lymph glands, and a sore
throat.
“At this point the virus is moving into the blood
stream and starting to replicate in large numbers,”
says Carlos Malvestutto, MD, instructor of infectious
diseases and immunology in the department of
medicine at NYU School of Medicine in New York City.
“As that happens, there is an inflammatory reaction
by the immune system.”
Fatigue
The inflammatory response generated by your
besieged immune system also can cause you to feel
tired and lethargic. Fatigue can be both an early and
later sign of HIV. Ron, 54, a public relations executive
in the Midwest, started to worry about his health
when he suddenly got winded just walking.
“Everything I did, I got out of breath,” he says.
“Before that I had been walking three miles a day.”
Ron had tested HIV positive 25 years before feeling
so tired; fatigue during acute, or newly contracted,
HIV might not be so obvious.
Achy Muscles & Joint Pain
ARS is often mistaken for the flu, mononucleosis, or
another viral infection, even syphilis or hepatitis.
That’s not surprising: Many of the symptoms are the
same, including pain in the joints and muscles and
swollen lymph glands. Lymph nodes are part of your
body’s immune system and tend to get inflamed
when there’s an infection. Many of them are located
in your armpit, groin, and neck.
Sore Throat & Headache
As with other symptoms, sore throat and headache
can often be recognized as ARS only in context, Dr.
Horberg says. If you’ve engaged recently in high-risk
behavior, an HIV test is a good idea. Get tested for
your own sake and for others: HIV is most infectious
in the earliest stage. Keep in mind that the body
hasn’t produced antibodies to HIV yet so an antibody
test may not pick it up. (It can take a few weeks to a
few monthsfor HIV antibodies to show in a blood
test). Investigate other test options such as one that
detects viral RNA, typically within nine days of
infection.
Skin Rashes
Skin rashes can occur early or late in the course of
HIV/AIDS. For Ron, this was another sign that he
might not have run-of-the-mill allergies or a cold.
”They were like boils, with some itchy pink areas on
my arms,” Ron says. The rashes can also appear on
the trunk of the body. “If [the rashes] aren’t easily
explained or easily treated, you should think about
having an HIV test,” Dr. Horberg says.
Nausea, Vomiting & Diarrhea
Anywhere from 30% to 60% of people have short-
term nausea, vomiting, or diarrhea in the early
stages of HIV, Dr. Malvestutto says. These symptoms
can also appear as a result of antiretroviral therapy
and later in the infection, usually as the result of an
opportunistic infection. ”Diarrhea that is unremitting
and not responding at all to usual therapy might be
an indication,” Dr. Horberg says. Or symptoms may
be caused by an organism not usually seen in people
with healthy immune systems, he adds.
Weight Loss
Once called “AIDS wasting,” weight loss is a sign of
more advanced illness and could be due in part to
severe diarrhea. ”If you’re already losing weight, that
means the immune system is usually fairly
depleted,” Dr. Malvestutto says. “This is the patient
who has lost a lot of weight even if they continue to
eat as much as possible. This is late presentation. We
still see a lot of these.” It has become less common,
however, thanks to antiretroviral therapy.
A person is considered to have wasting syndrome if
they lose 10% or more of their body weight and have
had diarrhea or weakness and fever for more than 30
days, according to the U.S. Department of Health and
Human Services.
Dry Cough
Have a bad cough that Benadryl, antibiotics, and
inhalers don’t seem to fix? This symptom—an
“insidious cough that could be going on for weeks
that doesn’t seem to resolve,” Dr. Malvestutto says—
is typical in very ill HIV patients.
Night Sweats
About half of people get night sweats during the
early stages of HIV infection, Dr. Malvestutto says.
These can be even more common later in infection
and aren’t related to exercise or the temperature of
the room. Similar to the hot flashes that menopausal
women suffer, they’re also hard to dismiss, given
that they soak your bedclothes and sheets.
Nail Changes
Another sign of late HIV infection are nail changes,
such as clubbing (thickening and curving of the
nails), splitting of the nails, or discoloration (black or
brown lines going either vertically or horizontally).
Often this is due to a fungal infection, such as
candida. “Patients with depleted immune systems
will be more susceptible to fungal infections,” Dr.
Malvestutto says.
Yeast Infections
Another fungal infection that’s common in later
stages is thrush, a mouth infection caused by
Candida, a type of yeast. ”It’s a very common fungus
and the one that causes yeast infections in women,”
Dr. Malvestutto says. “They tend to appear in the
mouth or esophagus, making it difficult to swallow.”
Ron woke up one day to find white patches on his
tongue. He had thrush. For him, “It was not
bothersome other than I didn’t like having it.” The
infection was hard to get rid of, but finally cleared up
after Ron started taking drugs to combat HIV.
Confusion or Difficulty Concentrating
Cognitive problems could be a sign of HIV-related
dementia, which usually occurs late in the course of
the disease. In addition to confusion and difficulty
concentrating, AIDS-related dementia might also
involve memory problems and behavioral issues such
as anger or irritability. It may even include motor
changes: becoming clumsy, lack of coordination, and
problems with tasks requiring fine motor skills such
as writing by hand.
Cold Sores or Genital Herpes
Cold sores (oral herpes) and genital herpes can be a
sign of both ARS and late-stage HIV infection. Having
herpes can also be a risk factor for contracting HIV.
This is because genital herpes can cause ulcers that
make it easier for HIV to enter the body during sex.
And people who have HIV tend to have more severe
herpes outbreaks more often because HIV weakens
the immune system.
Tingling & Weakness
Late HIV can also cause numbness and tingling in the
hands and feet. This is called peripheral neuropathy,
which also occurs in people with uncontrolled
diabetes. ”This is when the nerves are actually
damaged,” Dr. Malvestutto says. These symptoms
can be treated with over-the-counter pain relievers
and antiseizure medicines such as Neurontin
(gabapentin).
Menstrual Irregularities
Advanced HIV disease appears to increase the risk of
having menstrual irregularities, such as fewer and
lighter periods. These changes, however, probably
have more to do with the weight loss and poor health
of women with late-stage infection rather than the
infection itself. Infection with HIV also has been
associated with earlier age of menopause (47 to 48
years for infected women compared to 49 to 51 years
for uninfected women).





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