What Are the Signs and Symptoms of HIV in Women?
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.
What Is The Window Period For HIV Testing?
Key pointsThe window period refers to the time after infection and before seroconversion, during which markers of infection (p24 antigen and antibodies) are still absent or too scarce to be detectable. Tests cannot always detect HIV infection during the window period.
All tests have a window period, which varies from test to test. It also depends on the specimen that is being tested: window periods are usually reported based on a sample of blood plasma, but are longer when the specimen tested is fingerprick blood or oral fluid.
(Plasma is the colourless fluid part of blood, separated from whole blood using laboratory equipment. Fingerprick blood is produced by pricking the finger with a lancet, whereas oral fluid is obtained by swabbing the gums.)
There are two key questions to ask about a specific HIV test:
The information given in UK testing guidelines about window periods is based on answers to the second question – specifically, how long after exposure to HIV 99% of infections will be detected by a specific type of test. At this stage, it is highly likely that a negative result is accurate.
How long are the window periods of different HIV tests?It is hard to say exactly how long the window period lasts, as there are variations between individuals and it is a difficult topic to research (recently infected people would need to know exactly when they were exposed to HIV and then give multiple blood samples over the following days and weeks).
Nonetheless, a study by Dr Kevin Delaney and colleagues calculated window periods for a range of HIV testing assays. All these analyses were based on plasma samples. Window periods are likely to be several days longer when testing samples of fingerprick blood or of oral fluid, as will be normal when using rapid, point-of-care tests and self-testing devices. Unfortunately, precise figures for how much longer the window periods are have not yet been published.
NAM aidsmap's Matthew Hodson explains about window periods for HIV testing.
The researchers' analysis confirms that fourth-generation laboratory tests (which detect both antibodies and p24 antigen) detect HIV infections between one and three weeks earlier than older antibody-only tests. Moreover, their data suggest that some countries' guidelines which recommend retesting 90 days after a possible exposure to HIV are more cautious than they need to be.
A fourth-generation laboratory test is recommended in UK and US guidelines. It uses a sample of blood plasma or serum and can detect immunoglobulin G (IgG) antibodies, immunoglobulin M (IgM) antibodies and p24 viral antigen (a protein contained in HIV's viral core that can be detected sooner than antibodies). Commonly used tests of this type include Abbott Architect HIV Ag/Ab, GS Combo Ag/Ab EIA and Siemens Combo HIV Ag-Ab.
UK guidelines state that 45 days is the window period for fourth-generation laboratory tests.
A fourth-generation rapid test is available (Determine HIV Early Detect or Determine HIV-1/2). While results for this assay when testing plasma were broadly similar to those of equivalent laboratory tests, the window period is likely to be several days longer when testing fingerprick blood, as the test is normally used.
A few third-generation rapid, point-of-care tests are available. They can detect immunoglobulin G (IgG) antibodies and immunoglobulin M (IgM) antibodies. Examples include the INSTI HIV-1/HIV-2 and Uni-Gold Recombigen HIV tests. The estimated window period for INSTI when testing plasma are as follows:
However, those estimates were based on testing plasma. In practice, tests are usually done on fingerprick blood and the window period is likely to be several days longer.
UK guidelines state that 90 days is the window period for all rapid, point-of-care tests.
Third-generation laboratory tests are no longer recommended for use. They can detect immunoglobulin G (IgG) antibodies and immunoglobulin M (IgM) antibodies, but not p24 viral antigen. Their window periods are similar to those of the INSTI third generation rapid test (plasma samples), but a little shorter (median 23 days).
UK guidelines state that 60 days is the window period for third-generation laboratory tests.
Many rapid, point-of-care tests are described as second generation. They can detect immunoglobulin G (IgG) antibodies, but not immunoglobulin M (IgM) antibodies or p24 viral antigen. As these two substances are detectable sooner after HIV infection than IgG antibodies, second-generation tests have longer window periods. Examples include OraQuick Advance Rapid HIV 1/2, Clearview HIV 1/2 STAT-PACK and SURE CHECK HIV 1/2.
However, those estimates were based on testing plasma. In practice, tests are usually done on fingerprick blood or oral fluid and the window period is likely to be several days longer.
UK guidelines state that 90 days is the window period for all rapid, point-of-care tests.
Glossary window periodIn HIV testing, the period of time after infection and before seroconversion during which markers of infection are still absent or too scarce to be detectable. All tests have a window period, the length of which depends on the marker of infection (HIV RNA, p24 antigen or HIV antibodies) and the specific test used. During the window period, a person can have a negative result on an HIV test despite having HIV.
antibodyA protein substance (immunoglobulin) produced by the immune system in response to a foreign organism. Many diagnostic tests for HIV detect the presence of antibodies to HIV in blood.
plasmaThe fluid portion of the blood.
immunoglobulinAnother name for antibodies. An antibody is a protein substance produced by the immune system in response to a foreign organism (such as bacteria, virus or parasite).
point-of-care testA test in which all stages, including reading the result, can be conducted in a doctor's office or a community setting, without specialised laboratory equipment. Sometimes also described as a rapid test.
No self-testing devices were included in this study. However, most self-tests are modified versions of rapid, point-of-care test kits that were originally designed for healthcare professionals. Most are based on second- generation tests, so are likely to have relatively long window periods. A few, including the INSTI HIV Self Test, are based on a third-generation test.
Similarly, self-sampling was not included. In the UK, this usually involve the user sending a sample of fingerprick blood to be tested in a laboratory with a fourth-generation antibody/antigen test. Plasma is extracted from the sample using centrifugation. In theory, the test will be as accurate with plasma from a self-collected sample of fingerprick blood as from venous blood, including in relation to acute (recent) infection.
Are these figures always accurate?In some situations, these figures should be interpreted with caution:
What Are The Side-effects Of Post-exposure Prophylaxis (PEP)?
Key pointsPost-exposure prophylaxis (PEP) is a method of preventing HIV infection. It involves using a four-week course of the drugs used to treat HIV, taken very soon after a person may have been exposed to the virus.
PEP consists of three anti-HIV drugs. Two of these medications are from a class of drugs known as nucleoside reverse transcriptase inhibitors (NRTIs) and are usually taken together in a single pill. A third medication – from either the integrase inhibitor or protease inhibitor class of drugs – is taken separately. It is important to take all three drugs for PEP to be effective.
The British Association for Sexual Health and HIV (BASHH) recommends using a fixed-dose combination tablet combining emtricitabine and tenofovir (Truvada, or a generic alternative) from the NRTI class, and raltegravir (Isentress) from the integrase inhibitor class. Previously, BASHH guidelines recommended the protease inhibitor lopinavir/ritonavir (Kaletra) in place of raltegravir, but research shows that raltegravir causes fewer side-effects and fewer potential drug-drug interactions, and is associated with better adherence, than lopinavir/ritonavir. PEP is therefore easier to take than it used to be.
This page outlines the possible side-effects of the currently recommended combination of PEP medications, as well as the side-effects of other medications that may be used as alternatives.
Side-effects usually appear soon after starting PEP as the body adjusts to the new medications. Side-effects often lessen, become manageable, or go away completely after a few days or weeks.
Another point to bear in mind is that most of these data on side-effects come from HIV-positive people taking the same medications over many years as HIV treatment. Some possible long-term complications that are listed (such as raised liver enzymes) are highly unlikely to occur during a one-month course of the medication.
Emtricitabine/tenofovir + raltegravirThe recommended combination treatment of emtricitabine (200mg) and tenofovir (245mg) once daily, and raltegravir (400mg) every 12 hours is well tolerated.
That said, common side-effects (over 1% of people) of raltegravir include: loss of appetite, headache, difficulty in sleeping, abnormal dreams, depression, dizziness, vertigo, abdominal pain, bloating, flatulence, diarrhoea, nausea, vomiting, indigestion, rash, weakness, fatigue, fever, raised liver or pancreatic enzymes, and raised triglycerides.
Rarely, raltegravir can cause a hypersensitivity (allergic) reaction. If you develop a rash with other symptoms, such as a fever, seek medical advice.
The most common side-effects of emtricitabine/tenofovir are diarrhoea, being sick (vomiting), feeling sick (nausea), dizziness, headache, rash, feeling weak, pain, stomach pain, difficulty sleeping, abnormal dreams, feeling bloated, flatulence, allergic reactions, such as wheezing, swelling or feeling light-headed.
Emtricitabine/tenofovir can also affect the kidneys and bones, so an alternative drug may be offered to people with pre-existing severe kidney disease.
It should be noted that with the emtricitabine/tenofovir & raltegravir combination there have been occasional reports of muscle-related adverse events. These included reports of myalgia (muscle pain), and rhabdomyolysis (muscle damage that can lead to renal complications). Caution should therefore be taken in individuals with a history of these conditions or who are using other medications associated with these conditions, for example statins.
Australian doctors recently reported on how many of their patients taking this form of PEP reported side-effects. The most common side-effects were fatigue (37% of PEP users), diarrhoea (25%), nausea (24%), flatulence (24%), abdominal cramps (21%), bloating (16%), headache (15%), vivid dreams (15%), depression (10%) and thirst (10%).
For more information on these medications, see our factsheets on Truvada (emtricitabine/tenofovir) and raltegravir.
Alternative NRTI backbone: lamivudine/zidovudineBASHH guidelines state that zidovudine (250mg) and lamivudine (150mg), twice daily, may be used instead of emtricitabine/tenofovir. This combination may be preferred to emtricitabine/tenofovir in people with abnormal renal function, for example.
The most common reported side-effects (over 1% of people) of lamivudine/zidovudine taken together are: nausea, vomiting, diarrhoea, tiredness, headache, dizziness, weakness, muscle pain, loss of appetite, fever, abdominal pain, hair loss, insomnia, rash, cough, runny nose, joint or muscle pain, fat loss, anaemia, low white blood cell count and raised liver enzymes.
For more information, read our factsheet on lamivudine/zidovudine.
Alternative third agentsBASHH guidelines state that while raltegravir – an integrase inhibitor – is the first-line treatment in PEP, various boosted protease inhibitors may also be used if raltegravir is judged by the clinician to be unsuitable (for example, if there are concerns about intolerance). However, it should be noted that significant drug-drug interactions can occur with protease inhibitors.
Boosted protease inhibitors consist of one main protease inhibitor taken with a small quantity of ritonavir, another protease inhibitor. The purpose of a low dose of ritonavir is to 'boost' and maintain levels of the main protease in the body.
Boosted protease inhibitors that may be prescribed include lopinavir, darunavir or atazanavir.
Lopinavir/ritonavir (Kaletra)Lopinavir (200mg) and ritonavir (50mg), taken twice daily, frequently causes diarrhoea and other gastrointestinal disturbances.
"With all PEP regimens, your doctor or pharmacist should check for drug-drug interactions."
Other common side-effects (over 1% of people) include: nausea, sinus or throat infections, pancreatitis, vomiting, abdominal pain, bloating, flatulence, heartburn and indigestion, loss of appetite, raised lipids or blood sugar, diabetes, high blood pressure, rash, itching, skin infections, dizziness, tiredness, difficulty in sleeping, anxiety, weakness, headache, haemorrhoids, raised liver enzymes, allergic reaction including swelling, infections in the respiratory tract, cough, sore throat, runny nose, erectile dysfunction, menstrual disorders, peripheral nerve damage, muscle pain.
Due to these side-effects, BASHH recommends that doctors consider providing medications to prevent diarrhoea, nausea and vomiting alongside this form of PEP.
For more information, read our factsheet on lopinavir/ritonavir.
Darunavir/ritonavirDarunavir (800mg) may be prescribed with ritonavir (100mg) once daily.
Common side-effects of darunavir (over 1% of people) include: diarrhoea, vomiting, nausea, abdominal pain, bloating, indigestion, flatulence, headache, tiredness, dizziness, drowsiness, numbness, peripheral neuropathy (damage to nerves in the hands or feet causing tingling or pain), insomnia, weakness, rash, itching, diabetes, raised lipids, raised liver enzymes.
For more information, read our factsheet on darunavir.
Atazanavir/ritonavirAtazanavir (300mg) may be prescribed with ritonavir (100mg) once daily.
Common side-effects of atazanavir include: headache, nausea, vomiting, diarrhoea, abdominal pain, indigestion, tiredness, rash, and raised bilirubin levels. Developing some yellowing of the skin and/or eyes (jaundice) is fairly common when taking atazanavir, especially when you first start the drug. Although this can look alarming, it is harmless and does not mean that your liver is damaged, or not working in any way.
Glossary post-exposure prophylaxis (PEP)A month-long course of antiretroviral medicines taken after exposure or possible exposure to HIV, to reduce the risk of acquiring HIV.
proteaseAn enzyme that HIV uses to break up large proteins into smaller ones from which new HIV particles can be made.
diarrhoeaAbnormal bowel movements, characterised by loose, watery or frequent stools, three or more times a day.
nauseaThe feeling that one is about to vomit.
rashA rash is an area of irritated or swollen skin, affecting its colour, appearance, or texture. It may be localised in one part of the body or affect all the skin. Rashes are usually caused by inflammation of the skin, which can have many causes, including an allergic reaction to a medicine.
Rarely, atazanavir can cause a hypersensitivity (allergic) reaction. If you develop a rash with other symptoms, such as a fever, seek medical advice.
For more information, read our factsheet on atazanavir.
Dolutegravir (Tivicay)Dolutegravir is an integrase inhibitor that may be prescribed (50mg) once daily, as an alternative to raltegravir. It is not a protease inhibitor and is not taken with ritonavir.
Common side-effects associated with dolutegravir include: headache, insomnia, dizziness, abnormal dreams, depression, fatigue, diarrhoea, nausea, vomiting, abdominal pain or discomfort, flatulence, rash and itching.
Rarely, dolutegravir can cause a hypersensitivity (allergic) reaction. If you develop a rash with other symptoms, such as a fever, seek medical advice.
For more information, read our factsheet on dolutegravir.
Drug-drug interactionsWith all PEP regimens, your doctor or pharmacist should check for drug-drug interactions. This is especially a concern with PEP that contains a boosted protease inhibitor, but interactions can occur with other PEP medications.
A drug interaction is when one medicine affects how another medicine works. For example, taken together, one medicine may increase the side-effects of another medicine.
It is important to tell your doctor or pharmacist about all other medicines and drugs that you are taking – this includes those prescribed by another doctor; over-the-counter medicines (including inhalers and nasal sprays); supplements, herbal and alternative treatments; and recreational drugs.
The University of Liverpool provides an online tool to check for interactions between anti-HIV drugs, other medications and recreational drugs. You enter the names of the medication you are taking and the results are provided with a traffic-light system: if the result is red or amber, it's worth checking with your doctor or pharmacist. If it's green, there shouldn't be any problem. Visit www.Hiv-druginteractions.Org/checker.
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