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What Are The Signs And Symptoms Of HIV And AIDS (stage 3 HIV)?

The early signs and symptoms of HIV infection tend to be nonspecific. Within days or weeks of exposure to the virus, a person may notice flu-like symptoms, a rash, and fatigue. Some people may not have any symptoms.

A person's symptoms may vary depending on their stage of progression. For example, someone with stage 1 HIV may have different symptoms from someone with stage 3 HIV, also known as AIDS.

There are three stages of HIV. Below are the potential signs and symptoms of HIV depending on the stage of the condition:

Stage 1 HIV symptoms

Stage 1 HIV typically develops within 2 to 4 weeks of HIV transmission. Symptoms at this stage are often vague and unspecific, and may include:

Early symptoms are usually bearable and frequently mistaken for the flu or another mild condition. People may easily underestimate them or mistake them for minor health conditions.

Some people may not have any symptoms at this stage. However, they will have a significant amount of the HIV virus in their bloodstream, meaning it is easy to pass it on.

If someone thinks that they have HIV, they should speak with a healthcare professional as soon as possible.

Stage 2 HIV symptoms

Stage 2 HIV, or chronic HIV, may take around 10 years to progress to stage 3, although this process may be faster or slower for some people.

Some people may not have HIV-related symptoms during this stage, which is why healthcare professionals may also refer to this phase as the asymptomatic phase.

Others may experience general fatigue and enlarged lymph nodes in at least two sites for more than 3 to 6 months. People may also experience the following:

During this phase, HIV is still multiplying inside the body but at lower levels than in the acute phase.

Stage 3 HIV symptoms

Stage 3 HIV, also known as AIDS, may cause the following symptoms:

These symptoms may occur due to opportunistic infections, such as:

How HIV symptoms differ in males and females

While males and females may have many of the same early signs and symptoms of HIV, females may also experience symptoms such as genital yeast infections and changes in menstruation.

Males may also experience symptoms such as penile ulcers or erectile dysfunction.

Nonbinary and transgender people have a disproportionate burden of HIV, particularly transgender women. Factors that may contribute to this uneven burden may include discrimination, social stigma, and insensitivity to transgender-specific health needs.

Further research on HIV symptoms in transgender and nonbinary populations is necessary. However, transgender or nonbinary people may experience many of the same vague symptoms as cisgender people, such as fever, headaches, or ulcers.

According to estimates by the World Health Organization (WHO), around 20.5 million women and 18.1 million men globally were living with HIV in 2023.

However, higher numbers of males acquired HIV and experienced death due to HIV-related causes.

Although HIV remains a serious health concern, the Centers for Disease Control and Prevention (CDC) highlights that the number of people with HIV in the United States decreased by 12% from 2018 to 2022.

Some groups of people are affected more by HIV than others. For example, the CDC states that men in the United States who reported male-to-male sexual contact made up 67% of new HIV cases in 2022.

Learn more about global HIV statistics.

The only way to know if someone has HIV is to test for the virus. After exposure to the virus, there is a period in which tests will not detect the virus; the length of the period is specific to the test.

According to the CDC, healthcare professionals may diagnose HIV with the following tests:

Antibody tests: This test uses a blood or other bodily fluid sample to look for HIV antibodies. The test typically takes around 3 to 12 weeks to detect antibodies.

Antigen/antibody test: This test looks for antibodies and antigens, which are substances that the virus produces immediately after transmission. HIV produces the p24 antigen in the body even before antibodies develop. It may take 2 to 12 weeks to detect antibodies and antigens.

Nucleic acid test (NAT): This test looks for the HIV virus in a person's blood. It can detect HIV faster than the other types of tests. This test may take 1 to 5 weeks to detect HIV.

Usually, the above tests are evaluated in labs, but home tests are also available. Home tests, which are usually antibody tests, may require a small blood or saliva sample, and their results are quickly available. Some home tests give results in as little as 20 minutes.

If a home test is positive, it is essential to confirm the results with a doctor. If the test is negative, a person should repeat it after a few months to confirm the results.

How often should people test for HIV?

The CDC recommends that everyone between 13 and 64 years old take an HIV test at least once as part of their routine healthcare.

They also recommend that people with the following risk factors take a test at least once a year:

male-on-male sexual intercourse

anal or vaginal sex with someone who has HIV

multiple sexual partners since the last HIV test

exchanging sex for drugs or money

sharing drug injection equipment

diagnosis with tuberculosis, hepatitis, or a sexually transmitted infection

sexual intercourse with someone who has an unknown sexual history

sexual intercourse with someone who has done anything on this list

Learn more about HIV transmission.

HIV is a virus that weakens the immune system and leaves the body more prone to opportunistic diseases and infections.

Current treatments, such as antiretroviral therapy (ART), mean that stage 3 HIV is much less common. ART is a long-term treatment that lowers HIV levels in the body and stops the virus from replicating, allowing a person's immune system to grow stronger.

People with HIV can live long, healthy lives by combining HIV treatment and lifestyle measures, such as exercising regularly and quitting smoking if they smoke.

Learn about living with HIV.

How do people with HIV feel?

People with stage 1 HIV may experience generalized symptoms, such as fever, headache, or fatigue, that they may mistake for the flu.

Some people may not have any symptoms and may not know they have HIV until it progresses or they test positive.

What happens if someone gets HIV?

An acute HIV infection can take 2 to 4 weeks after transmission to develop. During this stage, a person will have high levels of HIV in the blood, which increases the risk of further transmission.

Treatment and diagnosis at this stage can offer significant health benefits.

How long do people with HIV live?

HIV treatment, including ART, reduces the level of HIV in the blood. This treatment can slow HIV progression, allowing people with HIV to live long, healthy lives.

People should get HIV treatment as soon as possible. Without treatment, a person with stage 3 HIV typically lives for around 3 years.

HIV symptoms vary depending on the stage of the condition. Early stage symptoms may be similar to those of the flu. People may experience headaches, fever, fatigue, and more.

As the condition progresses, a person may not have any symptoms. However, in stage 3 HIV, also known as AIDS, a person may experience severe symptoms related to opportunistic infections. This may include rapid weight loss, night sweats, and sores.

Early diagnosis and appropriate treatment can help slow the progression of the virus and significantly improve a person's quality of life. Knowing the early signs can help a person receive a quick diagnosis.

Read the article in Spanish.

HIV/AIDS

HIV (human immunodeficiency virus) is a viral infection transmitted through the sexual route. Intravenous needle sharing, infected blood transfusions and transmission from mother to child during birth and breastfeeding can also cause HIV infection. The symptoms become manifest two to four weeks after HIV infection. Symptoms can also be delayed for as long as ten months. HIV causes acquired immunodeficiency syndrome (AIDS) and can cause complications. Treatment of HIV / AIDS comprises antiretroviral drugs and lifestyle management. The patient may suffer from opportunistic infections, which are usually fatal. Hence control of infection in an HIV positive patient is a crucial part.

Types

HIV is classified into two different types:

HIV-1: HIV-1 is commonly found all around the world

HIV-2: HIV-2 is prevalent in Western Africa. It is uncommon elsewhere.

Stages

The stages and progression of HIV infection is as following:

Asymptomatic phase: HIV infection initial stages without any significant symptoms. However, changes in the immune system are noted. This phase can last up to 3 months. Primary infection to develop into HIV disease and immunosuppression takes many years.

Primary infection: The patient replicates the HIV in his bloodstream and lymph nodes in this phase of the disease.

Symptomatic stage: this is known as the late phase of HIV disease, also known as acquired immunodeficiency syndrome. The patient is at risk of developing opportunistic infections such as tuberculosis, candidiasis during this phase of infection.

Symptoms

Patients may remain asymptomatic initially after infection. Symptoms progress over two to three weeks after infection, the delay in symptoms for ten months has also been noted in many patients. Non-specific symptoms of HIV may occur during the Acute retroviral phase of the illness. Symptoms pointed out during this phase are as following-

Headache

Diarrhoea

Swollen lymph nodes

Fatigue

Skin rash

Night sweats

Sore throat

Joint pain

Muscle pain

The symptoms during chronic HIV infection symptoms of the following disease can be observed:

Chronic HIV infection without AIDS

Vaginal candidiasis

Herpes zoster

Thrush

Cervical dysplasia

Bacillary angiomatosis

Cervical carcinoma in situ

Chronic HIV infection with AIDS

Candidiasis

Recurrent Pneumonia

Chronic ulcers

Herpes simplex

HIV related encephalopathy etc.

Risk Factors

Following are the routes of acquiring HIV/AIDS infection:

Sexual transmission is a primary route of getting HIV infection

Blood transfusions from infected individuals

Needle sharing with an infected individual.

Transmission from an infected mother to child.

Prevention

The following measures can prevent the spread of HIV infection:

Sharing needle should be avoided. Discard it after using it once.

Use a clean condom; discard the used condom.

A pregnant female with HIV infection should be treated.

It is essential to inform the sexual partner if the individual is HIV positive.

Diagnosis

Screening test and confirmatory test are the mainstays for the diagnosis of HIV infection. A complete blood count is performed to assess thrombocytopenia, leukopenia or anaemia. CD4 cell count and viral load are also essential in the diagnosis of HIV infection. Differential diagnosis also plays a significant role in testing for HIV infection. For example, considering cardiovascular disorders, order cardiac biomarkers.

In the case of acquired immunodeficiency syndrome, pneumonia is a significant complication. Planning of chest X-Ray may be valuable to detect pulmonary infiltrates. Arterial blood gases provide essential information about an HIV infected person. Tuberculosis testing should be done. Sputum cultures are necessary for detecting bacterial infections. Other diagnostic tests such as CT scan may be crucial if disseminated TB is a possible diagnosis, especially in patients with acquired immunodeficiency syndrome. Individual with AIDS and decreased cd4 cell counts are at risk for pancreatitis and cholecystitis. Industries diagnostic tests such as bilirubin, transaminase and light base are functional.

Esophagogastroduodenoscopy is essential in patients with dysphagia. Diarrhoea is a common symptom in patients with AIDS. In these patients testing for bacteria, parasite, and ova should be performed. In severe refractory cases, colonoscopy is essential. Neurological complaints of HIV and AIDS should be detected using CT scan, CSF analysis, and lumbar puncture.

Treatment

Antiretroviral drugs: Antiretroviral drugs are the mainstay of treatment in HIV infected patients. Nucleoside/ nucleoid reverse transcriptase inhibitors in many combinations available. Along with this, CCR5 inhibitors and protease inhibitors are also used in the treatment of HIV infected patience.

Highly active antiretroviral therapy (HAART) is a vital part of HIV treatment.

Single tablet regimens of tenofovir disoproxil 245mg, Rilpivirine 25mg and Emtricitabine 200mg are used in a frequency of once daily. Associated side effects can be insomnia, flatulence, diarrhoea, nausea, vomiting, rash, weakness, fatigue, etc.

Elvitegravir 150mg/emtricitabine 200mg/cobicistat 150mg/tenofovir 245mg is given as once a day single tablet. Side effects such as fatigue, dizziness, flatulence, rash, sleepiness, and diarrhoea are associated with this drug.

Dolutegravir 50mg/abacavir 600mg/lamivudine 300mg is used as a single tablet daily. Side effects such as itching, depression, muscle pain running nose, indigestion, nausea, vomiting, fatigue loss of appetite can occur.

Nucleoside/ nucleotides reverse transcriptase inhibitors (NRTIs)

Abacavir in the dose of 300 MG tablet is given two times a day. Associated side effects can be abdominal pain, headache, tiredness, fever, nausea and vomiting.

Emtricitabine in the doze off of 200 mg capsule should be given once daily. Associated side effects can be diarrhoea, nausea, high creatinine kinase levels, headache, and dark skin.

Lamivudine tablet with a dose of 150 and 300 mg two times a day should be prescribed. Hair loss, nausea, vomiting, diarrhoea and joint pain are some Ill effects that can occur.

Zidovudine which comes in 100 and 250 mg capsules, should be given two times a day. Muscle pain, headache, nausea and vomiting, loss of appetite, fever, and fatigue are possible effects of the drug.

Tenofovir disoproxil 245 mg should be given once a day. Side effect such as rash, weakness, dizziness, headache for fatigue and stomach pain are associated with this drug.

Fixed-dose combinations of NRTI

Abacavir 600mg/Lamivudine 300mg once a day should be taken.

Abacavir 300mg/ Lamivudine 150mg/Zidovudine 300mg is another Fixed-dose combination used.

Emtricitabine 200mg/tenofovir disoproxil 245mg is available.

Lamivudine 150mg/Zidovudine 300mg once daily is another fixed-dose combination available to treat HIV.

Integrase inhibitors

Dolutegravir 50mg once or twice a day, Raltegravir 400mg tablet twice a day should be taken.

Non-nucleoside reverse transcriptase inhibitors (NNRTIs):

Ultrafine 100/200mg tablets and Rilpivirine 25mg tablets are taken.Maraviroc 150mg and 300mg tablets twice a day.

Protease Inhibitors

Atazanavir 150,200 and 300mg capsules once a day.

Darunavir 600 and 800 mg tablets once a day.

Lopinavir 20mg /ritonavir 50mg tablet twice a day.

Atazanavir 300mg/cobicistat 150mg taken once a day.

Lifestyle Management

Inform your sexual partners about your HIV status.

You must use clean needles for injecting drugs; dispose of them after use.

Circumcision reduces the risk of HIV infection.

Use of condoms containing a water-based lubricant that is more protective.

Pregnant women can take the treatment.

Prognosis And Complications

Prognosis

The progress of a patient suffering HIV with CD4 count greater than 500 lives a normal life compared to a person with a low CD4 level. Patients with AIDS who have untreated opportunistic infections have a low life expectancy.

Complications

A major complication to HIV is its progression to AIDS. It can be recognised when there is a low CD4 count with signs of opportunistic infections.

AIDS usually occurs when the lymphocyte count is below a specific level, and one of the following infections is present:

Tuberculosis

Cytomegalovirus

Candidiasis

Lymphoma

References

Stat Pearls. Acquired Immunodeficiency Syndrome. [Internet] [Updated on Sept 8, 2020] Available at https://www.Ncbi.Nlm.Nih.Gov/books/NBK537293/.

Stat Pearls. HIV disease current practice. [Internet] [Updated on Dec 30, 2020] Available at https://www.Ncbi.Nlm.Nih.Gov/books/NBK534860/.

Infectious disease reports. Pathogenesis of HIV Infection. [Internet] Available at https://www.Ncbi.Nlm.Nih.Gov/pmc/articles/PMC3892619/.

HHS Public Access. Barriers and facilitators to engagement in lifestyle interventions among individuals with HIV.[Internet] Available at https://www.Ncbi.Nlm.Nih.Gov/pmc/articles/PMC4130780/.

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