What are the common symptoms of Human Immunodeficiency Virus (HIV)?

Common Symptoms of HIV Infection

HIV infection typically remains asymptomatic for prolonged periods, with most adults remaining symptom-free for years despite ongoing viral replication, but when symptoms do occur, they follow predictable patterns based on disease stage and degree of immunosuppression. 1

Acute HIV Infection (Primary Illness)

• Mononucleosis-like syndrome occurs in at least 50% of cases within weeks after initial HIV exposure, presenting with fever, lymphadenopathy, and malaise 2
• This acute phase is characterized by intense viral replication and dissemination to lymphoid tissues 3

Early to Mid-Stage Disease (CD4 >200 cells/mm³)

Constitutional symptoms:

• Unexplained weight loss (can occur even with relatively preserved immune function) 1, 4
• Night sweats 1
• Fever 1
• Lack of energy/fatigue (reported by 65% of patients) 5

Dermatologic manifestations:

• Seborrheic dermatitis is one of the earliest and most persistent cutaneous markers, increasing in severity with disease progression 1, 6
• Fungal infections including tinea and onychomycosis, which become more diffuse and treatment-resistant as disease advances 6
• Psoriasis with increased severity 6
• Folliculitis 1, 6
• Herpes simplex and herpes zoster infections occur with increasing frequency as CD4 counts drop below 500 cells/mm³ 2

Oral manifestations:

• Oral candidiasis (thrush) 1
• Oral hairy leukoplakia 1, 2
• Aphthous ulcers 1
• Periodontal disease 1

Other common symptoms:

• Generalized lymphadenopathy (though this does not correlate with prognosis) 1
• Drowsiness (57% of patients) 5
• Difficulty sleeping (56% of patients) 5
• Pain (55% of patients) 5

Advanced Disease (CD4 <200 cells/mm³)

Critical warning signs requiring urgent evaluation:

• Fever, significant weight loss, dyspnea, persistent cough, or diarrhea lasting ≥2 weeks demand immediate medical attention 1, 7
• Swallowing difficulties (dysphagia/odynophagia) 1, 2
• Respiratory symptoms including shortness of breath and cough 1, 7

Opportunistic infection symptoms:

• Visual changes or vision loss (suggesting CMV retinitis or other ocular complications) 1
• Severe headaches, memory loss, confusion, or focal neurological deficits 1
• Persistent diarrhea 1, 7
• Chest pain 1

Advanced dermatologic findings:

• Kaposi sarcoma (violaceous skin lesions or oral lesions) 1, 6
• Prurigo nodularis 1, 6
• Molluscum contagiosum 1
• Severe or disseminated fungal infections 6

Systemic manifestations:

• Wasting syndrome 7, 2
• Anemia 2
• Changes in body habitus (lipodystrophy in those on antiretroviral therapy) 1

Neuropsychiatric Symptoms

• Depression is common and should be screened for regularly 1
• Changes in mood, libido, sleeping patterns, appetite, concentration, and memory 1
• Cognitive difficulties, dementia, and focal neuropathies may occur 1
• Lower extremity paresthesias, pain, or numbness (distal sensory neuropathy) 1

Important Clinical Pearls

The median time from HIV infection to AIDS development is 10 years, with 70-85% of infected adults eventually developing symptoms and 55-62% progressing to AIDS within 12 years 1. However, viral replication occurs continuously even during asymptomatic periods 1.

Symptom burden is significantly higher in those with an AIDS diagnosis and those currently receiving antiretroviral therapy 5. Women report more symptom burden than men after controlling for disease stage 5.

HIV-related complications are rarely encountered in patients with CD4 counts >500 cells/mm³, but the risk of opportunistic infections and malignancies increases progressively as CD4 counts fall below 200 cells/mm³ 2.

The presence of frequent or severe episodes of infections, or failure to respond appropriately to standard therapy, should prompt consideration of HIV infection as an underlying cause 1.