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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 symptomsStage 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 symptomsStage 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 symptomsStage 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 femalesWhile 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:
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:
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.
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.
New Study Highlights Potential Of Childhood Immunization Against HIV
Research at Weill Cornell Medicine suggests that childhood immunization against HIV could one day provide protection before risk of contracting this potentially fatal infection dramatically increases in adolescence.
The study, published Aug. 30 in Science Immunology, demonstrated that a series of six vaccinations containing a modified protein from the surface of HIV particles stimulated initial steps of a potent immune response in young non-human primates. This difficult-to-achieve response represents an important step toward providing full and potentially life-long protection against the virus, the researchers say.
Immunizing young children, rather than adults, makes sense because risk factors for HIV infection rise steeply when adolescents become sexually active, according to senior author Dr. Sallie Permar, the Nancy C. Paduano Professor in Pediatrics and chair of the Department of Pediatrics at Weill Cornell Medicine.
What's more, evidence suggests that the immune systems of infants and children generally mount more effective responses to the virus than those of adults. One of the advancements we've made is to demonstrate that an HIV vaccine could be delivered on a schedule similar to routine vaccines already given to babies and children."
Dr. Sallie Permar, the Nancy C. Paduano Professor in Pediatrics and chair of the Department of Pediatrics at Weill Cornell Medicine
Prepping the immune system earlyHIV predominantly infects immune cells called CD4 T cells, leaving individuals vulnerable to opportunistic diseases. Without lifelong treatment, infection is fatal. In 2022, an estimated 140,000 adolescents between 10 and 19 years old worldwide became infected with the virus—a group that is overrepresented in the number of new infections.
Vaccine researchers are seeking ways to stimulate the immune system to make "broadly neutralizing antibodies" against the virus before a person is exposed to it. These antibodies attack a crucial part of the HIV virus—the protein on its surface that binds to CD4 T cells. In doing so, broadly neutralizing antibodies prevent many strains of HIV from entering the cell and infecting it.
In this study, the researchers started with an experimental vaccine developed previously from spike proteins on the envelope of HIV particles. Study authors Dr. John Moore, a professor of microbiology and immunology, and Dr. Rogier Sanders, an adjunct associate professor of research in microbiology and immunology at Weill Cornell Medicine and a professor at Amsterdam UMC, sought to improve this vaccine by altering the viral protein. They designed these changes to stimulate a specific set of antibody-producing B cells that protect CD4 T cells.
"An effective HIV vaccine needs to engage the right set of B cells in order to generate a broadly protective response," said first author Dr. Ashley Nelson, an assistant professor of immunology research in pediatrics at Weill Cornell Medicine. "We discovered that introducing certain mutations into the envelope protein could accomplish that in the setting of a naïve immune system."
Activating the right B cells for protectionThe researchers administered the modified vaccine to five young primates in three priming doses, starting less than a week after birth. They followed up with three doses of the vaccine matching the original HIV envelope protein, with the last dose given when the animals reached 78 weeks old, roughly equivalent to four or five years old for a human. As a control, five animals received all six doses of the original envelope protein vaccine.
"While exposure to the modified protein got the immune response started off in the right direction, booster shots containing the original version of the viral protein were necessary to reach full potential," Dr. Nelson said.
Three of the five animals who received the modified version of the priming vaccine developed antibodies that appeared to be precursors to the sought-after broadly neutralizing response. Tests suggested these antibodies attacked the site the virus uses to invade CD4 T cells. However, they were not yet fully effective against the same breadth of HIV strains as mature broadly neutralizing antibodies. One of the three animals also showed signs of developing the mature, broadly neutralizing response.
The next step is figuring out how to reliably elicit a full-on broadly neutralizing response, Dr. Nelson said. "We still need to identify the right combination of viral proteins to get us further down that path, starting from the earliest stages in life when multi-dose vaccines are commonly given."
Source:
Journal reference:
Nelson, A. N., et al. (2024) Immunization with germ line–targeting SOSIP trimers elicits broadly neutralizing antibody precursors in infant macaques. Science Immunology. Doi.Org/10.1126/sciimmunol.Adm7097.
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