Unexplained rash, swollen lymph nodes, oral thrush, night sweats, and sudden and unexplained weight loss are all possible signs of human immunodeficiency virus (HIV). Some symptoms appear in the early stage of HIV, while others show up in later stages. However, not everyone will experience the same symptoms at the same stage.
The signs or symptoms of HIV are not always obvious, and most people who have HIV do not exhibit any of them. If you do have early (acute) symptoms, they're likely to appear in the first month or two after you've been infected. They may be similar to flu symptoms, including fever, headache, and fatigue.
These first signs of HIV differ from late-stage symptoms when the virus weakens your immune system. These persistent (chronic) symptoms indicate the progression of illness. They may include diarrhea for over one week, persistent cough, and rapid weight loss.
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Fever
Early acute HIV infection (AHI) can cause symptoms similar to the flu, including fever and chills. These symptoms may appear two to six weeks after you've been infected, and then go away. If your HIV remains untreated, they may return a few years later.
If you do get a fever, you will likely also have other flu-like symptoms. This is because your immune system is reacting to the virus as it replicates and moves through your system.
What Is ARS?
ARS stands for acute retroviral syndrome. This is the collection of HIV signs and symptoms that occur during acute HIV infection (AHI) when the immune system mounts a defense against the virus as it first enters the body. As many as two out of three people with acute-stage HIV do not know they have it.
Headache and Fatigue
AHI can also cause headaches and fatigue. This is because your body's initial immune response to the virus generates inflammation.
You may get tired much faster than usual and you may feel out of breath even after light activity. You may experience a persistent headache that can range from mild to severe.
Headache and fatigue can also be symptoms of later-stage HIV.
Swollen Lymph Nodes
Swollen lymph nodes (lymphadenopathy) can occur in the early stages of HIV as the body tries to kill the virus.
The lymph nodes of the armpits, neck, groin, or behind the ear may get bigger. Sometimes, the swelling is very noticeable. Swollen lymph nodes may hurt or be tender to the touch.
Even as the other signs of the acute HIV infection go away, swollen lymph nodes can persist in some people for many weeks or months.
Lymphadenopathy is also common with opportunistic infections like tuberculosis and HIV-associated cancers.
Sore Muscles and Joint Pain
Sore muscles and joint pain are common symptoms of many different viral illnesses. This symptom tends to occur alongside the other flu-like symptoms that are common in early HIV, such as fever, fatigue, and headache.
Unexplained Rash
A rash is often the first sign of HIV, but it only appears in two of every five newly infected people.
An HIV rash looks a certain way: large areas of flat, reddened skin peppered with tiny bumps. The rash can be itchy or painful. It often occurs alongside flu-like symptoms.
The HIV rash usually starts two to six weeks after exposure to the virus and will go away within one to two weeks. The rash is widespread and mainly affects the trunk and face, but can also be on the hands and feet.
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If you have a sudden rash with flu-like symptoms two to six weeks after having sex with a partner of unknown HIV status, you should get tested for HIV.
Nausea and Diarrhea
Some people also experience gastrointestinal (GI) symptoms during the early stage of HIV. GI symptoms may include nausea and vomiting and/or diarrhea.
GI symptoms can be present in many other illnesses, but they typically resolve quickly. If you have persistent nausea and vomiting or diarrhea, make sure you stay hydrated and see your healthcare provider.
Oral Thrush
One of the early opportunistic infections in people living with HIV is oral thrush. It is considered "opportunistic" because it takes the opportunity to infect a person when their immune system is weak.
Oral thrush is also called oral candidiasis. It's caused by a fungus that can invade the inside of the mouth and throat.
People who are relatively healthy can also get oral thrush, but it is a sign that their immune system is breaking down. When a person's immune system function is poor, the fungus can spread into the lungs and cause pneumonia. It can even spread to the bloodstream.
Having oral thrush does not automatically mean that you have HIV, but it could be a sign that you should get tested if you're at risk.
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Chronic symptoms of HIV develop as the virus breaks down the body's immune defenses, leaving it open to infection. During the chronic stage of HIV, many symptoms are non-specific, meaning a person may assume they are due to another cause.
Sore Throat and Dry Cough
Sore throat and dry cough can be symptoms of early HIV infection, but they also appear in later stages of HIV. In later stages, these are persistent symptoms that do not resolve with medications such as inhalers or antibiotics. They are often related to secondary lung infections, which are common in the later stages of HIV.
A persistent cough is always a reason to see your healthcare provider, especially if it's getting worse over time.
Night Sweats
Night sweats can occur during the acute stage as the body fights the virus and during the chronic phase if there is an opportunistic infection.
Also called sleep hyperhidrosis, night sweats are more than just being sweaty in your sleep—they will drench your clothes and bedding. Night sweats can also soak through these materials and cause shivers.
Drenching night sweats are never considered normal. You should let your provider know if you're having them.
Night sweats can have causes other than HIV, and some of them are not as serious as others—for example, menopause commonly causes night sweats but many types of cancer can as well.
Sudden, Unexplained Weight Loss
Weight loss is common in people living with HIV during the advanced stages of the disease.
This type of weight loss is more than just a few pounds—it's a sudden, unexplained weight loss of 10% or more of a person's body weight, in which both fat mass and lean muscle are lost.
The condition is also called HIV wasting syndrome. It's not as common today as it once was because antiretroviral drugs keep the virus suppressed and allow the immune system to rebuild itself. Wasting is mainly seen in people who have not been treated for HIV.
The exact cause of HIV wasting is unknown, but it is thought that the constant inflammation caused by HIV makes the body burn energy faster and reduces testosterone levels (which the body needs need to build lean muscle).
Other causes of wasting include malnutrition, chronic diarrhea, tuberculosis, and cancer—all of which require urgent diagnosis and treatment.
A Sexually Transmitted Infection (STI)
If you have a sexually transmitted infection (STI), there is a chance you may have HIV as well. Some STIs like syphilis and herpes cause open sores that make it easier for HIV to get inside the body.
STIs like gonorrhea and chlamydia cause inflammation in the genitals that attract the immune cells (CD4 T cells) that HIV likes to target and infect.
Having syphilis can increase your risk of HIV by as much as 500%. Other STIs can also raise your risk for HIV. You should be tested for HIV if you test positive for any STI.
Only an HIV testcan tell you for sure if you have the virus.
Sex Differences With HIV Signs
Biological females and males generally have the same symptoms of HIV, but females may also have frequent yeast infections and irregular periods. Females living with HIV are also at an increased risk of pelvic inflammatory disease and cervical cancer.
Summary
Many people who are HIV-positive do not know they have the virus. The only way to find out for sure is to get tested.
There are some clues that could mean you have HIV, especially if you're at risk. The first signs of HIV can seem like the flu with symptoms like fever, headache, and fatigue. Sometimes the first sign of HIV is a rash with flat, reddened skin and tiny bumps.
Late-stage symptoms may include recurring night sweats, diarrhea for more than a week, and rapid weight loss. Having another STI may also indicate that you're at risk for HIV.
Never assume that not having symptoms is the same thing as not having HIV. Not feeling sick does not mean that the virus is "mild" or that your immune system is not being harmed by it. If you are at risk of HIV, it's important to get tested and treated.
