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Symptoms & Causes
Find out more about the signs and symptoms of HIV infection, the causes of HIV, and how HIV causes AIDS.
Learn about early and late symptoms of HIV and AIDS.
HIV doesn't affect everyone the same way. Some people notice signs soon after they get the virus. Others don't.
Most of the time, the signs of HIV are the same for men and women. But there are a few symptoms that are unique to men.
The symptoms of HIV are mostly the same for men and women. But there are a few signs that happen only in women.
You have HIV. Now, you're getting symptoms you've never had before. It's possible your HIV isn't under control.
Most people who have HIV get a rash at some point. It's a common symptom that can happen in early or later stages of HIV.
The most common respiratory symptoms in people with HIV are shortness of breath and coughing.
HIV Patient With Movement Disorder Has Different Symptoms On Left And Right Sides
A 59-year-old woman with a background of HIV living with an uncontrollable movement disorder presented to Eoghan Donlon, MB, BCh BAO, MRCPI, of the Mater Misericordiae University Hospital in Dublin, Ireland, and colleagues.
Of note, the symptoms occurring on the left side of her body were very different than those on her right side, the team reported in JAMA Neurology.
They learned that the patient had been diagnosed with cerebral toxoplasmosis 18 months previously, shortly after the movement disorder first developed. At that time, she received antimicrobial treatment, but that had been largely ineffective.
On examination, Donlon and team observed cogwheel rigidity affecting her right upper limb, which moved very slowly, with tremor at rest. When clinicians assessed her gait, they noted reduced swing of her right arm. "In contrast, there were prominent hyperkinetic movements of the left side of her body with dystonic posturing of the left upper and lower limb and choreiform movements," they wrote.
The patient underwent a brain MRI with contrast that revealed several ring-enhancing lesions located in the right thalamus, left lentiform nucleus, right frontal lobe, and right posterior-temporal lobe.
Cerebrospinal fluid (CSF) analysis returned normal findings, with no evidence of HIV-1 and HIV-2. On blood tests, HIV viral load was undetectable; she had a CD4 count of 174. Neither serum nor CSF tests detected Toxoplasma DNA.
Donlon and colleagues performed a CT scan of the patient's brain and compared the findings to a scan from 18 months before. Evidence of increased calcification of all lesions suggested the diagnosis of chronic toxoplasmosis. The team considered that the hemiparkinsonism affecting the patient's right side was due to the lesion in the left lentiform nucleus, and the hemidystonia of her left limbs was caused by the lesion in the right thalamus.
They recommended a short trial of risperidone 0.5 mg daily; however, the patient experienced adverse effects of flattened mood and orobuccal dyskinesia, and declined to continue with treatment.
Discussion
Opportunistic infection with cerebral toxoplasmosis is not uncommon in patients with HIV, and as this case demonstrates, may be associated with movement disorders.
During the HIV epidemic, data suggested that 2% to 3% of patients with HIV were affected by movement disorders, particularly parkinsonism and tremor, Donlon and team said. However, they cautioned that use of neuroleptic medications to manage neuropsychiatric complications may have a confounding effect.
Of hyperkinetic movement disorders that may be associated with HIV infection, hemiballismus and hemichorea are reported most commonly, especially in the setting of toxoplasmosis, since it frequently involves the basal ganglia structures, the group noted.
"The presence of hemichorea-hemiballism in patients with AIDS is felt to be pathognomonic of cerebral toxoplasmosis," they wrote.
A series of 64 cases found that the rates of the various manifestations of movement disorders associated with toxoplasmosis were:
There is scarce evidence regarding response to treatment of toxoplasmosis, Donlon and team said. As in this patient's case, treatment may improve symptoms but not necessarily resolve them.
In three of the 64 cases that reported treatment outcomes, "response to levodopa was mild to absent." And while treating the infection tends to improve chorea, "there are few reports of response to symptomatic treatment (apart from 1 report of partial response to tetrabenazine)," the authors wrote.
Kate Kneisel is a freelance medical journalist based in Belleville, Ontario.
Disclosures
The authors reported no conflicts of interest.
Primary Source
JAMA Neurology
Source Reference: Donlon E, et al "Alternate hemibody hyperkinetic and hypokinetic movement disorders due to strategic lesions in cerebral toxoplasmosis" JAMA Neurol 2023; DOI: 10.1001/jamaneurol.2023.2709.
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Trump Launched An Ambitious Effort To End HIV. House Republicans Want To Defund It.
Updated August 31, 2023 at 8:45 AM ET
More than four years ago, then-President Donald Trump declared an ambitious goal that had bipartisan support: ending the HIV epidemic in the United States.
Now, that Trump program is one of several health initiatives targeted for substantial cuts by members of his own party as they eye next year's elections.
Pushing a slate of conservative political priorities that also takes aim at sex education for teens, health worker vaccine mandates, and more, Republicans in the House of Representatives have proposed a spending bill that would cut $1.6 billion from the Centers for Disease Control and Prevention — one-sixth of the agency's budget.
Zeroing out CDC's part of Trump's planThe proposal would zero out the agency's share of the Trump HIV plan, which was more than a third of the program's budget in the current fiscal year. It would also eliminate funding through other channels, such as the Health Resources and Services Administration's Ryan White HIV/AIDS Program.
With another budget fight and potential government shutdown looming Oct. 1, the specific proposal is unlikely to clear Congress. Still, former CDC officials said they fear it is the opening bid on what could nonetheless be debilitating reductions to a strained agency that has lost some public support in recent years.
The cuts come on the heels of other recent reductions at the CDC, triggered by the 11th-hour debt-ceiling deal, to its budgets for childhood vaccination programs and prevention of sexually transmitted infections. And they provide an early opportunity for the CDC's new director, Mandy Cohen, to show how well she can convince members of Congress to protect the agency's interests in a polarized political landscape.
"Public health is being politicized to a point that's never been seen," said Kyle McGowan, of consulting firm Ascendant Strategic Partners, who served as chief of staff at the CDC during the Trump administration. Cutting public health spending "is not smart," he said. "These culture wars are now leaking into and harming public health."
He called the proposed cuts unprecedented in their targeting of bipartisan public health initiatives.
CDC targeted for cuts, againThe House Republican spending proposal, which came from members of the Labor, Health and Human Services, Education subcommittee, also targets programs that have drawn the ire of conservative lawmakers, such as those that focus on climate change and gun violence research.
"Cuts to the Centers for Disease Control and Prevention are as outrageous as they are dangerous," said Connecticut Rep. Rosa DeLauro, the highest-ranking Democrat on the subcommittee.
But Rep. Kay Granger, the Texas Republican who chairs the House Appropriations Committee, said the bill "works to responsibly fund programs that help improve the health and lives of the American people. It also holds agencies accountable when there has been a history of poor performance or controversial activities."
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Rep. Kay Granger, Republican of Texas, chairs the powerful House Appropriations committee.Granger and the chair of the subcommittee that drafted the bill, Rep. Robert Aderholt (R-Ala.), did not respond to requests for further information.
The House Appropriations Committee has yet to mark up and vote on the measure, which would also need the approval of the full Republican-controlled House and Democratic-controlled Senate. The Senate Appropriations Committee has approved its own health spending bill, which largely maintains existing CDC funding for HIV and would require the two chambers to work together to produce a consensus measure.
And any spending measure would also need the signature of President Joe Biden, whose most recent budget proposal included a request for $850 million to reduce new HIV cases.
The CDC declined to comment on the possible cuts, saying it would be premature to do so amid the ongoing budget process.
Ambitious goals, significant headwindsThe Trump administration's HIV program launched in 2019 with the goal of cutting new infections nationwide by 90% by 2030. It has sent more than $1.7 billion, through different federal health agencies, to HIV hot spots around the country.
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A World AIDS Day event at The Wall Las Memorias AIDS Monument on December 1, 2022 in Los Angeles. There are about 35,000 new HIV infections per year in the U.S.But the program has run into significant headwinds. The covid-19 pandemic diverted the attention of public health officials. Plus, red tape, along with persistent stigma and discrimination fueled by anti-LGBTQ+ messaging from politicians, have many health officials worried it won't meet its ambitious goals.
House Republicans said the HIV program, well shy of its first main milestone, in 2025, hasn't met its goals.
"This program has demonstrated a lack of performance data based on outcomes, insufficient budget justifications, and vague spend plans. The initiative has not met its original objectives," the Republican-led subcommittee wrote in a report that KFF Health News obtained but could not independently verify as official. Granger and Aderholt did not respond to requests to verify the document.
Trump's Ending the HIV Epidemic initiative isn't the only Republican-created HIV program being targeted.
Bush's PEPFAR also derailed by Republicans of 2023A number of key provisions in the President's Emergency Plan for AIDS Relief, known as PEPFAR, are set to expire on Sept. 30. The program, which funds HIV and AIDS prevention around the world, has saved millions of lives, and is widely seen as a public health and foreign policy success. It was launched in 2003 under then-president George W. Bush.
But discussions about reauthorizing the program have been derailed by Republican claims it finances abortion. PEPFAR won't immediately stop its work, but missing the deadline could signal an uncertain future for the program, experts say.
Regarding the Trump HIV initiative, service providers say any budget reductions would slow the progress it has made in the fight against the disease.
"There's a lot at stake here," said Justin Smith, of Positive Impact Health Centers, an Atlanta-area HIV clinic. Smith has helped Georgia public health officials plan the distribution of Ending the HIV Epidemic funds among the four priority counties in the state.
Smith said the proposed cuts would be "quite devastating" for the work being done in Cobb, DeKalb, Fulton, and Gwinnett counties in metropolitan Atlanta. That work has included ramping up HIV testing and PrEP, or preexposure prophylaxis, programs, as well as expanding care for transgender people living with the virus.
New HIV funds flowing to the South, where they're neededThe South has the highest rate of new HIV diagnoses in the country, and many Ending the HIV Epidemic target areas are in the region.
In Louisiana, which has two of those HIV priority areas, the program has helped reduce the number of late HIV diagnoses and maintain levels of viral suppression, said Samuel Burgess, the director of the state's STI and HIV prevention program.
Even if the budget cuts don't survive the legislative process fully intact, it's "very concerning" that lawmakers would even propose such a cut, Burgess said.
HIV policy advocates are pushing back on the House Republican proposal. In July, the Federal AIDS Policy Partnership sent a letter to House appropriators warning of its potential impact.
"We are deeply concerned that this bill will not only stop progress being made to achieve the goals set forth by former President Trump in 2019, but will exacerbate the HIV epidemic which has plagued our nation for 40 years," they wrote.
Quick challenge for the new CDC directorCohen, who started with the CDC in July, is familiar with the budget process, having spent time in top leadership positions within the U.S. Department of Health and Human Services.
But she's new to the CDC and, regardless of her inside-the-Beltway experience, will need time to get up to speed, which could potentially leave the agency vulnerable, said McGowan. "It's a difficult time to have a leadership change at the CDC," he said. But he added that "Dr. Cohen is doing a great job meeting with everyone on the Hill, both Democrats and Republicans."
The fights over HIV programs concern Tom Frieden, who served as CDC director under former President Barack Obama. He estimated he made more than 250 trips to Capitol Hill over nearly eight years to sell the agency's work to lawmakers.
He called the Atlanta-based CDC's location outside of Washington a "double-edged sword."
"People used to say to me, 'Gee, isn't it great, we're not bugged by politicians down here in Atlanta?'" Frieden said.
While the location helps cushion the agency from politics, he said, it also makes it harder to get support from members of Congress.
But the CDC's response to covid pulled it back into the political fray. Frieden said he is hopeful the Democratic-controlled Senate will act as a "hard stop" against the Republican attacks — but he warned that substantial cuts can slip through the cracks.
"It's always a risk that some important stuff at the 11th hour doesn't happen," Frieden said.
KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
Copyright 2023 KFF Health News. To see more, visit KFF Health News.
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