HIV symptoms
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Now I have comprehensive information to provide a thorough answer on HIV symptoms organized by stage.
HIV Symptoms
HIV infection progresses through three distinct stages, each with characteristic symptoms.
Stage 1 — Acute HIV Infection (Acute Retroviral Syndrome)
Timing: 2–6 weeks after exposure (median ~25 days); lasts 2–6 weeks.
Up to 50–80% of newly infected individuals develop an acute retroviral syndrome resembling infectious mononucleosis or influenza. 10–40% remain asymptomatic.
Common symptoms include:
| Symptom | Notes |
|---|---|
| Fever | Most common feature |
| Lymphadenopathy | Nontender; axillary, cervical, occipital nodes; may persist mildly |
| Pharyngitis | Pharyngeal edema and hyperemia, usually without exudate |
| Rash | Faint, generalized; small (5–10 mm) pink-to-red macules/maculopapules; appears 48–72 hrs after fever onset, lasts 5–8 days |
| Myalgia / Arthralgia | |
| Headache | Often retroorbital, worsened by eye movement |
| Fatigue / Malaise | |
| Diarrhea | |
| Anorexia / Weight loss | |
| Night sweats | |
| Mucocutaneous ulcers | One of the most distinctive findings; oral or genital |
| Hepatosplenomegaly | Less common |
Neurological (less common): Aseptic meningitis (severe headache, meningismus, photophobia, lymphocytic pleocytosis in CSF). Rarely: seizures.
Opportunistic infections in acute phase (rare): Oral/esophageal candidiasis is most common; PCP, CMV, and cryptosporidiosis may also occur.
The acute retroviral syndrome is easily missed — its differential includes mononucleosis, toxoplasmosis, rubella, syphilis, viral hepatitis, and disseminated gonorrhea. — Goldman-Cecil Medicine
Stage 2 — Clinical Latency (Chronic Phase)
Timing: Months to years (typically 8–10 years if untreated)
- Patient is largely asymptomatic or may have minor, recurrent infections.
- Virus replicates at low levels, primarily in lymphoid tissue.
- CD4+ T-cell count gradually declines.
- 5–10% are "rapid progressors" developing AIDS within a few years; ~5% are long-term nonprogressors.
Stage 3 — AIDS
Defined by: CD4+ count < 200 cells/mm³ (normal: 500–1600/mm³), or the presence of an AIDS-defining illness.
Constitutional symptoms:
- Recurring or persistent fever
- Drenching night sweats
- Rapid, unexplained weight loss (HIV wasting syndrome)
- Chronic diarrhea (> 1 week)
- Profound fatigue
AIDS-defining opportunistic infections:
| Category | Organisms |
|---|---|
| Protozoa | Toxoplasma gondii, Cryptosporidium |
| Bacteria | Mycobacterium avium complex (MAC), Nocardia, Salmonella |
| Fungi | Candida (oral thrush, esophagitis), Cryptococcus neoformans, Pneumocystis jirovecii (PCP), Histoplasma, Coccidioides |
| Viruses | CMV (retinitis, colitis), HSV, VZV |
AIDS-defining malignancies:
- Kaposi sarcoma
- B-cell lymphomas (including EBV-associated)
- Cervical carcinoma (invasive)
Other AIDS complications:
- HIV-associated neurocognitive disorder (HAND) — formerly AIDS encephalopathy; caused by direct neuronal damage from viral proteins (gp120, Tat) and inflammatory cytokines from infected microglia
- HIV nephropathy — kidney failure
- Cachexia — driven by TNF and other inflammatory cytokines affecting appetite and metabolism
Key Points
- Severity of acute illness predicts prognosis — a more severe acute syndrome correlates with higher viral load and faster progression.
- ART has transformed HIV into a manageable chronic disease; with treatment, progression to AIDS is largely preventable.
- CD4 count and viral load set-point (measured 1–3 months after infection) are the most useful predictors of disease progression.
- Patients who stop ART after achieving viral suppression can develop acute retroviral syndrome again within 10 days to 4 weeks.
Sources: Goldman-Cecil Medicine International Edition; Sherris & Ryan's Medical Microbiology, 8th ed.; Cellular and Molecular Immunology (Abbas); Harrison's Principles of Internal Medicine 22E.
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