Sexually Transmitted Infections (STIs): Sexually Transmitted Diseases (STDs)
The Stages Of HIV Infection
Key pointsMost descriptions of the stages of HIV infection describe the natural history of HIV, in other words how, over time, the disease progresses in people who are not taking HIV treatment. They show how HIV progressively attacks and weakens the immune system, eventually leading to AIDS (acquired immune deficiency syndrome).
This is not what happens to people who take effective HIV treatment (antiretroviral therapy). These medications can keep the virus under control and stop a decline in health. They profoundly change the course of infection.
The following description of the stages of HIV infection takes account of the impact of HIV treatment.
Seroconversion and acute HIV infectionIn the first few weeks after infection with HIV, some people have a short flu-like illness that is called a 'seroconversion illness'. This coincides with the period during which the body first produces antibodies to HIV. The most commonly experienced symptoms are fever, swollen glands, muscle aches and tiredness.
The severity of symptoms at this stage can vary considerably between people – they can be so mild as to go unnoticed, or so severe that admission to hospital is needed. They usually go away within two to three weeks.
This early stage of HIV infection is called acute HIV infection. The US public health agency the Centers for Disease Control and Prevention (CDC) describes it as stage 0.
During acute infection, there are very high levels of HIV in the body (a high viral load), which means that the risk of passing HIV on is higher than at other times.
You can start HIV treatment during acute infection. HIV treatment lowers the amount of virus in the body, which allows the immune system to strengthen and helps prevent illnesses from occurring. Starting HIV treatment in this early phase may have particular benefits in terms of preserving the immune system.
People who start HIV treatment go straight to the 'chronic' stage of infection, described towards the end of the page.
Asymptomatic HIV infectionOnce you have passed through the primary infection phase, you usually enter a phase in which you don't have any symptoms or obvious health problems, even if you are not yet taking HIV treatment. This period can last for several years.
In the classification system of the World Health Organization (WHO), this is stage 1 (asymptomatic). In the slightly different system of the CDC, it is also described as stage 1 (but defined in terms of a CD4 cell count above 500).
'Asymptomatic' means 'without symptoms'. It does not mean HIV is not having an effect on your immune system, just that there are no outward signs or symptoms. Blood tests will show how active HIV is inside the body and the impact it is having on your immune system. The viral load test will usually show that the virus is replicating, while the CD4 cell count will give a rough indication of the strength of your immune system.
The sooner you start to take HIV treatment, the sooner you can benefit from it. If you do so, you can skip the next two stages and go straight to the 'chronic' stage of infection, described towards the end of the page.
Symptomatic HIV infectionThe longer you live with HIV without treatment, the further your CD4 cell count will fall. This is a sign that your immune system is being weakened and that there is a greater risk of developing symptoms.
Glossary chronic infectionWhen somebody has had an infection for at least six months. See also 'acute infection'.
immune systemThe body's mechanisms for fighting infections and eradicating dysfunctional cells.
symptomAny perceptible, subjective change in the body or its functions that signals the presence of a disease or condition, as reported by the patient.
acute infectionThe very first few weeks of infection, until the body has created antibodies against the infection. During acute HIV infection, HIV is highly infectious because the virus is multiplying at a very rapid rate. The symptoms of acute HIV infection can include fever, rash, chills, headache, fatigue, nausea, diarrhoea, sore throat, night sweats, appetite loss, mouth ulcers, swollen lymph nodes, muscle and joint aches – all of them symptoms of an acute inflammation (immune reaction).
effectivenessHow well something works (in real life conditions). See also 'efficacy'.
Symptoms may include skin disorders, prolonged diarrhoea, night sweats, thrush, bacterial pneumonia, fatigue, joint pain, and weight loss. Opportunistic infections that the immune system is normally able to fight off may begin to occur.
In the WHO classification, this is stage 2 (mild symptoms) and stage 3 (advanced symptoms). In the CDC system, it corresponds with stage 2 (a CD4 count between 200 and 500).
Many people only get tested for HIV and receive their HIV diagnosis at this stage. This may be described as a 'late diagnosis'. If you are diagnosed late, it means that you have already had HIV for several years without taking treatment.
Nonetheless, you can start to take treatment now and it will still be effective. It will strengthen your immune system, reduce the amount of HIV in your body and prevent illnesses from occurring. You can skip the next stage and move on to 'chronic' HIV infection.
AIDSIf somebody goes a very long time without treatment, the most serious stage of infection can occur. This is known as AIDS (acquired immune deficiency syndrome) or advanced HIV disease. It refers to a range of serious illnesses that people may get when HIV has significantly weakened their immune system.
For WHO, this is stage 4 (severe symptoms). In the CDC system, it is stage 3 (a CD4 count below 200).
Thanks to effective HIV treatment, most people with HIV never develop AIDS. The syndrome most often develops in people who are diagnosed at a very late stage and so were living with untreated HIV for many years.
If someone develops an AIDS-defining illness, this doesn't mean that they are on a one-way path to illness and death. With the right HIV treatment and care, many people who have been diagnosed as having AIDS recover from their AIDS-related illness and go on to have long and healthy lives. They move on to the following stage: chronic HIV infection.
Chronic HIV infection with antiretroviral treatmentIf you take effective HIV treatment, you can live with HIV as a chronic, manageable condition. A 'chronic' health condition is one which continues for a long period of time.
This stage is not included in most descriptions of the stages of infection, which only describe disease progression in the absence of treatment.
However, most people living with HIV who have access to good healthcare are living with HIV as a chronic condition – and will continue to do so for the rest of their lives. They are unlikely to fall ill or die as a direct result of HIV.
In order to reach this stage and to remain in it, you need to take HIV treatment and continue to take it, on an ongoing basis. These medications reduce levels of HIV in your body and strengthen the immune system. This usually prevents the symptoms and opportunistic infections described above from occurring.
Some immune system damage and inflammation does persist. This is one of the reasons why people living with chronic HIV are more vulnerable to some other health conditions, including heart disease, diabetes and cancer.
One of the benefits of effective HIV treatment is that is stops HIV from being passed on. Treatment drastically reduces the amount of HIV in body fluids to the point where there is not enough HIV to transmit the virus to sexual partners.
The chronic infection phase can last for decades. People who start HIV treatment as soon as possible, are able to stick with it and have access to good healthcare are likely to have a similar life expectancy to their peers who don't have HIV.
What Does An HIV Rash Look Like?
A rash can be an early symptom of HIV, but HIV can also increase the risk of developing different types of rashes. The rash may be discolored and include mild itchiness.
People who develop a rash and believe they may have had exposure to HIV should seek medical advice. If an HIV infection is present, treatment can help manage it effectively.
HIV transmits from one person to another when bodily fluids come into contact with each other. These include blood, semen, rectal and vaginal fluids, and breast milk.
Exposure to HIV can happen if a person has sex or shares needles with someone who has the virus.
In this article, find out what an HIV rash looks like, what causes rashes linked to HIV, and what to do if they happen.
The following images here show some ways in which HIV may affect the skin.
No single rash is specific to HIV. As HIV involves changes in the immune system, it can trigger a variety of skin reactions.
However, the rash that occurs at the early stage usually appears flushed, discolored, or reddish in people with fair skin, or dark purplish in people with dark skin. The blemishes are flat, and there may be mild itchiness.
A rash can be an early sign of HIV, occurring as a result of seroconversion. This is the acute, or early stage, of HIV, which usually occurs 2–4 weeks after exposure to the virus.
During the seroconversion or acute HIV stage, the body produces antibodies to the virus. Between 50-90% of all people with HIV experience flu-like symptoms at this stage, and some people may develop a rash.
Sometimes, a rash is the only symptom of HIV, but because HIV impacts the immune system, there are often other symptoms, too.
Early symptoms of an HIV infection that can occur alongside a rash include:
According to the Centers for Disease Control and Prevention (CDC), these symptoms may appear 2–4 weeks after exposure and last between a few days and several weeks.
Anyone who experiences these symptoms after possible exposure to HIV should seek advice about testing.
If a rash occurs as a symptom of the acute stage of HIV, it will usually go away as the immune system produces antibodies to HIV.
After this, however, if a person is not taking medications to control HIV, they may have a higher chance of developing further rashes and skin problems. This is because HIV leads to a weakened immune system.
When the immune system is compromised, it becomes easier for viruses, fungi, bacteria, parasites, and other causes to trigger a rash.
Conditions that may appear with skin symptoms include:
In some cases, treatment for HIV can trigger an allergic skin reaction.
A rash that appears during seroconversion will usually disappear without intervention, but other types of rash may occur later.
HIV-related rashes vary greatly. The chance of developing a rash will depend on factors such as:
In time, other rashes can develop due to conditions, such as herpes and psoriasis. People with these conditions have symptoms that often improve or disappear for a while but then return.
The severity of each outbreak varies but depends partly on the immune function. Some medications, such as antiviral drugs for herpes, can reduce the severity of each outbreak.
Learn more about how psoriasis and HIV are related.
Acute skin conditionsRashes that result from an infection will go away with appropriate treatment.
However, due to HIV's impact on the immune system, infections can become more likely. A previous rash may return, or a new one may appear.
Medication-related rashesDrugs for treating HIV can sometimes trigger a rash. Anyone who believes they have a rash due to their medication should speak to a member of their healthcare team. It is often possible to switch to another drug.
It is essential to speak to a doctor before changing or discontinuing treatment.
Taking antiviral medication keeps viral levels low and reduces HIV's impact on the immune system. Many people can now live a healthy life with HIV, but it is essential to follow the treatment plan.
Learn more here about living with HIV.
Prompt testing and early treatment are effective at stopping the progress of HIV, and early treatment for a rash can help prevent complications.
TestingAnyone who develops a rash or flu-like symptoms should seek medical advice if they think they have come into contact with HIV.
They can undergo a test for HIV. If the result is positive, a healthcare team can help them develop a treatment plan that will help them stay healthy.
With current medication, it is possible to reduce the level of virus in the body to undetectable levels. The risk of diseases and infections falls, and a person cannot transmit HIV to another person. In other words, undetectable = untransmittable.
The CDC provides a locator to help people locate HIV testing services in their area.
Rash treatmentPeople who already have a diagnosis of HIV should see a doctor if a new rash develops or an existing rash gets worse.
Emergency medical attention may be necessary if:
Drug reactionsIn rare cases, HIV medications can trigger a serious hypersensitivity reaction known as Stevens-Johnson syndrome.
Symptoms include:
If anyone experiences these symptoms or other symptoms that may indicate a hypersensitivity or allergy — such as dizziness and breathing difficulty — they should seek urgent medical attention.
How to identify HIV rash?An HIV rash typically emerges during the acute phase of infection and may be itchy, painful, and accompanied by flu-like symptoms such as fever and swollen lymph nodes.
It usually appears flushed, discolored, or reddish in people with fair skin, or dark purplish in people with dark skin.
However, the presence of a rash alone does not provide a definitive diagnosis of HIV. Early testing is crucial for prompt management if HIV infection is confirmed.
What can be mistaken for HIV?HIV can be mistaken for the following:
Where do HIV lesions first appear?Generally speaking, HIV lesions can appear on the face, chest, abdomen, arms, and legs.
What does your skin look like when you have HIV?Skin appearance in people with HIV varies widely, with no specific indicator unique to the virus.
Some may develop rashes during acute infection, while others might experience opportunistic infections like fungal, bacterial, or viral skin conditions due to a weakened immune system. Drug reactions and skin disorders are also possible.
Consulting a healthcare professional for proper evaluation and testing is crucial if a person is concerned about skin health or HIV status.
The rash that appears in the early stage of HIV typically manifests as flushed, discolored, or reddish in individuals with fair skin, and dark purplish in those with dark skin.
A rash may also occur due to HIV medications or other infections.
Early testing and treatment for HIV can help a person live a healthy life and reduce the risk of developing HIV-associated infections and other conditions.
If anyone thinks they have come into contact with HIV, they should ask about a test, especially if they develop a rash and other symptoms within the following few weeks after exposure.
Read the article in Spanish.
5 RARE Symptoms Of HIV & How To Beat Them!
If you or someone you know has HIV, you're probably well aware of the problems it can cause. From the flu-like conditions of the acute stage to the infections of the chronic stage and the serious immune problems of AIDS, the progression of HIV comes with more than its fair share of struggles and challenges.
Fortunately, with a comprehensive lifestyle approach, proper medication, and a positive attitude, many people with the condition are living happy, healthy lives.
But did you know that other issues may crop up? Some that aren't as common as the symptoms we've come to understand?
If you aren't familiar with some of the rare symptoms and conditions of HIV, now's the time to get informed.
Here are five rare issues of HIV, and what you can do to beat them!
1. LipodystrophyA condition where your body fat is abnormally distributed, lipodystrophy can cause significant changes in your appearance. This can lead to fat loss on the face, as well as in your appendages, your abdomen, your breasts, and even the back of the neck.
If you start noticing a hollowed sunken look in some parts of your body and a bloated, protruding look in other parts, it may be lipodystrophy. Your best bet to defeating this condition is through antiretroviral therapy (ART). Getting consistent exercise and eating better are also obviously important. In some cases, cosmetic surgery may be effective. This could include things like fillers and liposuction.
2. HIV-Associated Nephropathy (HIVAN)Nephropathy means damage or disease of the kidneys. So, HIVAN is just damage/disease brought on by unregulated challenges from HIV. You will typically notice this disease through swelling of your feet, ankles, and legs. Your bathroom habits may also change. For instance, you may urinate less and when you do urinate it may come out foamy.
There are various ways to overcome HIVAN. Firstly, you should get regular kidney function tests. As with lipodystrophy, antiretroviral therapy (ART) is also useful, helping to prevent HIVAN from ever developing. Meds such as ACE inhibitors and 'receptor blockers' are also effective, so be sure to ask your healthcare team about those.
As for lifestyle modifications, consider things like lowering your blood pressure, eating better, and taking supplements for your kidneys, such as CoQ10, Omega-3s, B vitamins, and probiotics.
RELATED: 13 HIV Symptoms that Look Like Something Else
3. Bacillary AngiomatosisA bacterial infection, bacillary angiomatosis typically leads to skin lesions and full-body or systemic symptoms. The good news is, it's more common in those HIV patients with severely compromised immune systems. If you're infected, you'll notice raised and red lesions, general fatigue, swelling of the lymph nodes, and fever.
The best way to beat this is by using antibiotics like the widely prescribed doxycycline or erythromycin. As with all of these conditions, antiretroviral therapy (ART) is of course another important piece of the treatment puzzle. You should also do your own at-home checks, noting any changes in your skin appearance and health.
4. Progressive Multifocal Leukoencephalopathy (PML)A long, complicated name, PML is basically a rare and frequently fatal infection of the brain (not good!).
Then again, there is good news. Unless you have a very compromised immune system, the JC virus responsible for this condition won't give you trouble. People with advanced HIV/AIDS, however, need to be careful.
When suffering from PML, you'll typically experience weakness on one side of your body, trouble with speech comprehension, problems with your vision, and potentially significant cognitive deficits.
Because PML is a late-game condition, there are no specific treatment protocols. That said, you can regularly monitor your neurological activity, boost your immune system with antiretroviral therapy, and consult your doctor to manage any symptoms.
5. ThrombocytopeniaThrombocytopenia is a condition where you lack platelets, meaning you can bruise and bleed quite easily. A simple bump or hard contact can become a problem. You may also notice little red spots beneath your skin (petechiae) as well as blood from your nose and gums. Aside from continuing to use antiretroviral therapy, you should employ steroids or something called immune globulin, which can help your body produce more platelets.
Also, try to limit the use of any blood-thinning medications and conduct regular blood tests, as these can help you keep your condition at bay.
As you can see with these five conditions, living with HIV poses many unique challenges. However, with a proactive approach, the right healthcare team, and targeted treatments, you can conquer this thing day by day!
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