December 7, 2019

16 Signs You May Have HIV

HIV symptoms

Human immunodeficiency virus, or HIV, attacks the body’s infection-fighting immune system. Without treatment, HIV can lead to AIDS (acquired immunodeficiency syndrome). At the start of the AIDS epidemic in the 1980s, people who were infected with HIV quickly progressed to serious disease. But today’s treatments help lower the amount of virus in the blood—so people who are HIV-positive can live healthier, longer lives and not necessarily progress to AIDS.

More than one million people in the US live with HIV, and scarily, one in seven of them don’t know they have it. HIV symptoms can be hard to detect. Within a month or two of HIV entering the body, 40% to 90% of people experience flu-like symptoms known as acute retroviral syndrome (ARS). But sometimes HIV symptoms don’t appear for years—or even a decade—after infection.

“In the early stages of HIV infection, the most common symptoms are none,” Michael Horberg, MD, director of HIV/AIDS for Kaiser Permanente, in Oakland, California, tells Health. As many as one in five people in the United States with HIV doesn’t know they have it, according to the Centers for Disease Control (CDC). That’s why it’s so important to get tested, especially if you currently have or have had unprotected sex with more than one partner or use intravenous drugs.

HIV symptoms for women and for men are often the same; here are 16 of the most common signs.

Fever

One of the first signs of HIV can be a mild fever, up to about 102 degrees F. The fever, if it occurs at all, is often accompanied by other usually mild symptoms, such as fatigue, swollen lymph glands, and a sore throat.

“At this point, the virus is moving into the bloodstream and starting to replicate in large numbers,” Carlos Malvestutto, MD, instructor of infectious diseases and immunology at NYU Langone Medical Center in New York City, tells Health. “As that happens, there is an inflammatory reaction by the immune system.”

Fatigue

The inflammatory response generated by your besieged immune system also can cause you to feel tired and lethargic. Fatigue can be both an early and later sign of HIV.

Ron, 54, a public relations executive in the Midwest, started to worry about his health when he suddenly got winded just walking. “Everything I did, I got out of breath,” he says. “Before that I had been walking three miles a day.” Ron went for a test and found out he was HIV positive.

Achy muscles, joint pain, swollen lymph nodes

HIV infection is often mistaken for the flu, mononucleosis, or another viral infection, even syphilis or hepatitis. That’s not surprising. Many of the symptoms are the same, including pain in the joints and muscles and swollen lymph glands.

Lymph nodes are part of your body’s immune system and tend to get inflamed when you have an infection. Many lymph nodes are located in your armpit, groin, and neck.


Sore throat 

A sore throat can be a symptom of an initial HIV infection. People who’ve had HIV for a while may also get sore throats thanks to a secondary infection like oral thrush or cytomegalovirus, both common in people with HIV.

Symptoms like these can often only be recognized in context, says Dr. Horberg. If you’ve engaged in high-risk behavior, or you have a chronic sore throat you can’t seem to shake, an HIV test is a good idea. 

Skin rash

Skin rashes can occur early or late in the course of an HIV infection, and can even be a sign of AIDS. The rashes might be bacterial or viral, or caused by an overgrowth of yeast that naturally lives on the skin. 

For Ron, this was another sign that he might not have run-of-the-mill allergies or a cold. “They were like boils, with some itchy pink areas on my arms,” Ron tells Health. The rashes can also appear anywhere on the body.

“If [the rashes] aren’t easily explained or easily treated, you should think about having an HIV test,” Dr. Horberg says.

Nausea, vomiting, diarrhea

Between 30% to 60% of people have short-term nausea, vomiting, or diarrhea in the early stages of HIV, Dr. Malvestutto says. These symptoms can also appear (and become chronic) as a result of antiretroviral drug therapy and as the result of an opportunistic infection.

“Diarrhea that is unremitting and not responding at all to usual therapy might be an indication” of HIV infection, Dr. Horberg suggests. Diarrhea and other GI symptoms might also be caused by an organism not usually seen in people with healthy immune systems, he adds.

Weight loss

Once called “AIDS wasting,” weight loss is a sign of more advanced HIV infection and could be due in part to severe diarrhea.

“If you’re already losing weight, that means the immune system is usually fairly depleted,” Dr. Malvestutto says. “This is the patient who has lost a lot of weight even if they continue to eat as much as possible. This is late presentation. We still see a lot of these.” It has become less common, however, thanks to antiretroviral therapy.

A person is considered to have wasting syndrome if they lose 10% or more of their body weight and have had diarrhea or weakness and fever for more than 30 days, according to the U.S. Department of Health and Human Services.

Dry cough

A dry cough was the first sign Ron had that something was wrong. He at first dismissed it as bad allergies. But it went on for a year and a half—and kept getting worse. Benadryl, antibiotics, and inhalers didn’t fix the problem. Neither did allergists.

This symptom—an “insidious cough that could be going on for weeks that doesn’t seem to resolve,” Dr. Malvestutto says—is typical in people with advanced HIV infection or AIDS. At the same time, a dry cough can happen for a number of reasons unrelated to HIV, so checking in with a doctor to find out what’s really going on is crucial.

Pneumonia

A cough and unexplained weight loss may also presage a more serious infection: pneumonia, which is often caused by a germ that wouldn’t bother you if your immune system was working properly.

“There are many different opportunistic infections and each one can present differently,” Dr. Malvestutto says. In Ron’s case, it was pneumocystis pneumonia (PCP), aka “AIDS pneumonia,” because people with healthy immune systems don’t usually get it.

There are many different types of pneumonia, which is an infection of lung tissue by either bacteria, a virus, or a fungus. Signs of pneumonia include a high fever and shortness of breath. Treatment depends on the type of pneumonia your doctor diagnoses you with. 

Other opportunistic infections include toxoplasmosis, a parasitic infection that affects the brain; a type of herpes virus called cytomegalovirus; and yeast infections like thrush.

Pneumonia

A cough and unexplained weight loss may also presage a more serious infection: pneumonia, which is often caused by a germ that wouldn’t bother you if your immune system was working properly.

“There are many different opportunistic infections and each one can present differently,” Dr. Malvestutto says. In Ron’s case, it was pneumocystis pneumonia (PCP), aka “AIDS pneumonia,” because people with healthy immune systems don’t usually get it.

There are many different types of pneumonia, which is an infection of lung tissue by either bacteria, a virus, or a fungus. Signs of pneumonia include a high fever and shortness of breath. Treatment depends on the type of pneumonia your doctor diagnoses you with. 

Other opportunistic infections include toxoplasmosis, a parasitic infection that affects the brain; a type of herpes virus called cytomegalovirus; and yeast infections like thrush.

Night sweats

About half of people get night sweats during the early stages of HIV infection, Dr. Malvestutto says; this HIV symptom is the body’s reaction when it becomes overheated or is trying to fend off an infectious agent. Night sweats can be even more common later in infection and aren’t related to exercise or the temperature of the room.

Similar to the hot flashes that menopausal women suffer, they’re also hard to dismiss, given that they soak your bedclothes and sheets.

Nail changes

Another sign of late HIV infection is nail changes, such as clubbing (thickening and curving of the nails), splitting of the nails, or discoloration (black or brown lines going either vertically or horizontally).

Often this is due to a fungal infection, such as candida (aka, yeast). “Patients with depleted immune systems will be more susceptible to fungal infections,” Dr. Malvestutto says.

Yeast infections

Another infection that’s common in advanced HIV cases is a vaginal yeast infection, caused by an overgrowth of candida, a type of yeast that naturally live in the vagina. Signs include itching and thick vaginal discharge. 

An overgrowth of candida can also lead to thrush, which is a yeast infection in the mouth. Symptoms of thrush are white patches in the mouth and throat as well as redness, burning, and soreness.

“It’s a very common fungus,” Dr. Malvestutto says. The yeast tends to “appear in the mouth or esophagus, making it difficult to swallow,” he adds.

Ron woke up one day to find white patches on his tongue. He had thrush. For him, “It was not bothersome other than I didn’t like having it.” The infection was hard to get rid of, but finally cleared up after Ron started taking drugs to combat HIV.

Confusion or difficulty concentrating

Cognitive problems could be a sign of HIV-related dementia, which usually occurs late in the course of the infection, when a person has developed AIDS.

In addition to confusion and difficulty concentrating, HIV-related dementia might also involve memory problems and behavioral issues, such as anger or irritability.

It may even include motor changes: becoming clumsy, lack of coordination, and problems with tasks requiring fine motor skills such as writing by hand.

Cold sores or genital herpes

Cold sores (oral herpes) and genital herpes can both be symptoms of HIV infection. 

Having herpes can also be a risk factor for contracting HIV. This is because herpes can cause ulcers that make it easier for HIV to enter the body during sex. People who have HIV tend to have more severe herpes outbreaks more often because HIV weakens the immune system and makes a person more susceptible to outbreaks.

Tingling and weakness

A lesser-known symptom of HIV is numbness and tingling in the hands and feet. This is called peripheral neuropathy, a condition that also occurs in people with uncontrolled diabetes. 

“This is when the nerves are actually damaged,” Dr. Malvestutto says. Peripheral neuropathy can be treated with over-the-counter pain relievers and antiseizure medicines such as Neurontin (gabapentin).

Menstrual irregularities

Advanced HIV appears to increase the likelihood of menstrual irregularities, such as fewer and lighter periods. These changes, however, probably have more to do with the weight loss and poor health of women with late-stage infection rather than the infection itself.

Infection with HIV also has been associated with earlier age of menopause (47 to 48 years for infected women compared to 49 to 51 years for uninfected women). Women with HIV may also experience more intense menopause side effects, according to a 2016 study review.

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