HIV, or Human Immunodeficiency Virus, is a virus that weakens the immune system. While there is no cure for HIV, antiretroviral drugs have been available since the late 1980s to help manage the effects of HIV symptoms. Once contracted, HIV typically remains in the body for life, but its symptoms manifest in stages. Without treatment, the infection progresses into AIDS, the disease's final stage, with distinct symptoms and complications at each phase. Antiretroviral treatment can reduce HIV to undetectable levels in the blood, preventing progression to later stages and transmission during sex.
Stages of HIV Infection
HIV infection progresses through three main stages:
- Acute HIV Infection (Stage 1): This is the earliest stage, occurring within 2 to 4 weeks after infection. During this time, the virus replicates rapidly, and the blood contains high levels of the virus, making transmission very likely. About two-thirds of people experience flu-like symptoms, while others may not notice any symptoms.
- Chronic HIV Infection (Stage 2): Also known as clinical latency or asymptomatic HIV infection, this stage can last for 10 to 15 years or longer without treatment. The virus continues to multiply at low levels, and the person may not feel sick or have any symptoms. However, the virus can still be transmitted to others.
- AIDS (Stage 3): This is the most advanced stage of HIV infection, occurring when the immune system is severely damaged. A CD4 count below 200 cells per cubic millimeter (mm3) of blood or the presence of opportunistic infections indicates progression to AIDS.
Timeline of HIV Symptoms
The symptoms of HIV infection vary from person to person, and many people may not know they are infected until years after exposure. The disease is progressive, with symptoms becoming more serious as the immune system weakens.
Early Stage: Acute HIV Infection (2-4 Weeks After Exposure)
In the early stage after an exposure, symptoms may include flu or cold symptoms. These can resolve spontaneously while HIV is still active in the body. The acute stage, also known as acute retroviral syndrome (ARS), occurs immediately after infection, before the immune system controls the virus. About two-thirds of people experience mild to moderate flu-like symptoms, while the rest experience no symptoms.
Common ARS symptoms include:
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- Fever
- Fatigue
- Headache
- Sore throat
- Muscle aches
- Joint pain
- Swollen lymph nodes
- Night sweats
- Nausea
- Diarrhea
- Generalized rash of pink to red bumps
The average duration of ARS symptoms is 14 days, but some people may experience symptoms for up to three months.
Chronic HIV Infection (Weeks to Years After Exposure)
After the acute stage, HIV may transition to the clinically latent infection stage. In some people, no noticeable symptoms appear, which is why it is referred to as asymptomatic or chronic HIV infection. This stage can last up to 10 or 15 years, during which the virus replicates slowly but remains transmissible.
Symptoms of chronic HIV can vary, ranging from minimal to more severe. People may experience episodes of:
- Enlarged lymph nodes
- Oral and skin conditions
- Unintentional weight loss
- Diarrhea
- Fatigue
During the early chronic phase, lymphadenopathy may be the only notable sign of HIV infection. As immune deficiency develops, nonspecific symptoms may appear, including:
- Oral candidiasis (thrush)
- Unexplained fevers or weight loss
- Severe, uncontrolled diarrhea that lasts for more than three days
Late-Stage HIV and AIDS (Years After Exposure)
If left untreated, HIV will almost invariably lead to symptomatic disease. The timing of this progression varies. A person's immune health, measured by the CD4 count, determines the risk of opportunistic illnesses. AIDS, or acquired immunodeficiency syndrome, is the final stage of HIV and is defined by a CD4 count under 200 or the presence of AIDS-defining conditions.
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Symptoms of stage 3 HIV include:
- Persistent high fevers over 100°F (37.8°C)
- Diarrhea that lasts longer than a week
- Severe chills and night sweats
- White spots in the mouth
- Genital or anal sores
- Severe fatigue
- Rashes that can be brown, red, purple, or pink in color
- Regular coughing and breathing problems
- Significant weight loss
- Persistent headaches
- Memory problems and other neurological issues
- Opportunistic infections, such as pneumonia or tuberculosis
- Related cancers, such as lymphoma or Kaposi sarcoma
HIV and Weight Loss
Unintentional weight loss is a significant symptom of HIV infection, particularly in the chronic and late stages. Several factors contribute to weight loss in people with HIV:
- Opportunistic Infections: Infections like tuberculosis, salmonella, and candidiasis can cause weight loss due to increased metabolic demands and decreased appetite.
- Malabsorption: HIV and certain opportunistic infections can damage the digestive system, leading to malabsorption of nutrients and subsequent weight loss.
- Metabolic Changes: HIV can cause metabolic changes that increase energy expenditure, leading to weight loss even with adequate food intake.
- Decreased Appetite: Symptoms like nausea, vomiting, and oral sores can decrease appetite and reduce food intake, contributing to weight loss.
- Medications: Some medications used to treat HIV and opportunistic infections can cause side effects like nausea, diarrhea, and loss of appetite, which can lead to weight loss.
Significant weight loss is one of the symptoms of stage 3 HIV.
HIV Testing and Treatment
The CDC recommends that anyone between the ages of 13 and 64 get tested at least once for HIV. Individuals with a higher chance of contracting HIV are advised to test at least once every year.
Different types of tests are available, each with a different window period-the time between potential exposure to HIV and when a test can detect the virus.
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- Nucleic acid tests: Detect HIV infection between 10 and 33 days after exposure.
- Antigen/antibody tests (blood from a vein): Typical window period of 18 to 45 days.
- Finger-prick antigen/antibody tests: Can be used 18 to 90 days after potential exposure.
- Finger-prick rapid self-test antibody test: Can be used 23 to 90 days after potential exposure.
It’s important to start treatment as soon as you receive an HIV diagnosis. Antiretroviral drugs can help manage the infection by stopping the virus from replicating, reducing the amount of virus inside the body. Medications help:
- Prevent progression of the disease
- Maintain quality of life
- Stop the transmission of the virus to other people via sex
Preventing HIV Progression
The most effective way to prevent HIV from progressing is to take antiretroviral medication as soon as possible and to do so consistently as a doctor prescribes.
Additional strategies to boost the immune system include:
- Avoiding infections: Take steps to protect against infections and illnesses, such as getting regular vaccinations if a doctor recommends it.
- Reducing stress: Stress weakens the immune system.
- Using condoms during sexual intercourse: Condoms protect people with HIV from other sexually transmitted infections.
- Exercising regularly: Regular physical activity brings many benefits.
- Eating a balanced diet: Maintaining a nutritious, balanced diet with a low alcohol intake helps boost the immune system and ward off infections.
- Quitting smoking: People with HIV who smoke are more likely to develop infections and illnesses.