Symptoms of HIV Infection
HIV infection presents with a wide spectrum of clinical manifestations ranging from an acute flu-like illness during primary infection (occurring in 40-90% of cases) to progressive immunodeficiency leading to opportunistic infections and AIDS-defining conditions. 1
Acute HIV Infection (Primary HIV Infection)
The acute retroviral syndrome occurs in 65-95% of newly infected individuals within the first few weeks after HIV exposure, before antibody tests become positive. 2, 1
Common Acute Symptoms:
- Fever (often >37.7°C) 3, 1
- Malaise and fatigue 1, 3
- Lymphadenopathy (swollen or enlarged lymph nodes, often generalized) 1, 3
- Skin rash (typically macular-papular) 1
- Sore throat and pharyngitis 1, 3
- Myalgia and arthralgia (muscle and joint pains) 1
- Headache 3, 1
- Night sweats 3, 4
Additional Acute Manifestations:
This acute syndrome resembles influenza or mononucleosis and is often not recognized by clinicians, leading to missed opportunities for early diagnosis. 1 The majority of seroconversions may occur without any prolonged symptoms, making clinical diagnosis challenging. 3
Asymptomatic Phase
Most adults and adolescents infected with HIV remain symptom-free for long periods (median 10 years), though viral replication continues and the immune system progressively deteriorates. 1
Early Symptomatic HIV (CD4 >200 cells/mm³)
As CD4 counts decline below 500 cells/mm³, certain conditions become more frequent: 5
- Recurrent mucocutaneous herpes simplex 5
- Herpes zoster (shingles) 5
- Oral candidiasis (thrush) 1, 5
- Oral hairy leukoplakia 1, 5
- Seborrheic dermatitis 1
- Immune thrombocytopenia 5
Constitutional Symptoms:
Advanced HIV/AIDS (CD4 <200 cells/mm³)
The risk of opportunistic infections and AIDS-defining malignancies increases progressively as CD4 counts fall below 200 cells/mm³. 5
Pattern-Based Presentations:
Respiratory symptoms: 5
- Pneumonia (especially Pneumocystis jirovecii)
- Cough and shortness of breath
- Tuberculosis
Gastrointestinal symptoms: 5
- Dysphagia/odynophagia (difficulty/painful swallowing)
- Chronic diarrhea
- Nausea and abdominal pain
- Persistent severe headaches
- Memory loss and cognitive difficulties
- Loss of concentration
- Depression, anxiety, mood changes
- Peripheral neuropathy (lower extremity paresthesias, pain, numbness)
- Seizures
- Focal motor or sensory deficits
Dermatologic manifestations: 1
- Kaposi sarcoma
- Molluscum contagiosum
- Severe psoriasis
- Condylomata
- Cutaneous fungal infections
Other manifestations: 5
- Fever and wasting syndrome
- Visual loss (often from CMV retinitis)
- Anemia
- Generalized lymphadenopathy
Critical Clinical Pitfalls
The non-specificity of acute HIV symptoms means they have low positive predictive value in isolation, but in high-risk populations (recent unprotected sexual contact, needle sharing, sexual assault), these symptoms should prompt immediate HIV testing including nucleic acid testing. 1, 3
Acute retroviral syndrome occurs before antibody seroconversion, so standard antibody tests will be negative or indeterminate—HIV RNA testing by PCR is essential for diagnosis during this window period. 1
Night sweats combined with fever and unexplained weight loss (B symptoms) significantly increases concern for serious pathology including advanced HIV, tuberculosis, or lymphoma. 4