What Is the First Sign of HIV? Symptoms and Causes

Early symptoms of the human immunodeficiency virus (HIV) are referred to as primary or acute HIV infection.

Human immunodeficiency virus (HIV) is a virus that attacks the body's immune system, which is responsible for fighting infections. People with untreated HIV infection don’t fight off infections or cancer as well as healthy people and they can become sick easily. 

Acquired immune deficiency syndrome (AIDS) describes the late stage of HIV infection. In the U.S., most people infected with HIV do not go on to develop AIDS because HIV medicines are available that can stop the progression of the disease.

Early symptoms of the human immunodeficiency virus (HIV) are referred to as primary or acute HIV infection. These symptoms usually occur two to four weeks after a person is infected with the virus and include: 

• Fever
• Sore throat
• Headache
• Muscle pain
• Joint pain
• Flu-like symptoms 
• Swollen lymph nodes
• Skin rash
• Painful open sores or ulcers that can develop in the mouth, the esophagus, the anus, or the penis (only occurs in a small proportion of those exposed to the virus)
• Nausea 
• Vomiting
• Diarrhea
• Lack of appetite
• Weight loss
• Dry cough 

These first symptoms last about 2 weeks and are usually mild. Many people don’t even recognize they have HIV at this point. 

After several years, if HIV is not treated, other symptoms may occur:

• Swelling of lymph nodes, usually in the neck, armpit, or groin
• Fever
• Stomach pain
• Nausea
• Vomiting
• Diarrhea
• Weight loss
• Other infections (opportunistic infections)
  • Lung infections that can cause shortness of breath
  • Brain infections
  • Eye infections that cause trouble seeing and blurred vision
  • Candidiasis of the mouth (oral thrush) that can cause soreness and raise, white patches

Human immunodeficiency virus (HIV) infection is caused by exposure to the human immunodeficiency virus. The virus is transmitted via blood or through sexual intercourse and exposure to other bodily fluids (such as semen or vaginal fluids) from a person with HIV. HIV infection is NOT spread by casual contact.

HIV infection can occur if a person:

• Has unprotected sex (without using a condom) with someone who has HIV
  • This includes vaginal, anal, and oral sex
• Shares needles or syringes with a person infected with HIV
• A pregnant woman can transmit HIV to her baby during pregnancy, birth, or breastfeeding
  • This is uncommon with the use of HIV medications during and after pregnancy

People who may have an increased risk of HIV infection include:

• Men who have sex with other men
• Drug users who share needles or “works”
• Sexual partners of people who are infected with HIV
• People with a history of a sexually transmitted disease (STD)
• Victims of sexual assault 
• People who have unprotected sex with multiple partners
• People who exchange sex for money or drugs or have sex partners who do
• Anyone accidentally stuck with a needle or sharp in a health care facility
• People who received a blood transfusion or other blood products before 1984 
• Blood products were not routinely screened for HIV prior to 1984

Human immunodeficiency virus (HIV) is diagnosed with either a blood test or a saliva (spit) test. 

Rapid HIV test results are available in minutes, though some test results can take days.

There are also HIV test kits available at some pharmacies that can be used at home. One test uses a special strip to collect a small amount of blood, and another kit has a strip that is wiped on the gums. The strips are mailed to a lab for testing. If you use an at-home HIV test kit and results come back positive, see your doctor. 

Human immunodeficiency virus (HIV) is usually treated with different combinations of antiretroviral medicines that work to keep HIV infection controlled.

Early HIV infection is often treated with one of the following antiretroviral therapy (ART) regimens: 

• Bictegravir-tenofovir alafenamide-emtricitabine
• Ritonavir-boosted darunavir plus tenofovir and either emtricitabine or lamivudine

Without treatment, human immunodeficiency virus (HIV) progresses through three stages. With the availability of antiretroviral therapy (ART) medications, progression to Stage 3 (AIDS) is not as common as it used to be.

Stage 1: Acute HIV Infection

• There is a large amount of HIV in the blood
• Patients are very contagious
• Flu-like symptoms may occur, but some people may not feel sick
• Only antigen/antibody tests or nucleic acid tests (NATs) can diagnose acute infection

Stage 2: Chronic HIV Infection (asymptomatic HIV infection or clinical latency)

• HIV is still active but reproduces at very low levels
• People may not have any symptoms during this phase
• Without HIV medication, stage 2 may last a decade or longer in some patients
• HIV can be transmitted in this phase
• At the end of stage 2, the viral load (the amount of HIV in the blood) rises and the CD4 cell count goes down
• Symptoms may occur as virus levels increase in the body, and the person progresses to stage 3
• If HIV medications are taken as prescribed patients may not progress to stage 3

Stage 3: Acquired Immunodeficiency Syndrome (AIDS)

• This is the most severe phase of HIV infection
• AIDS damages the immune system and patients can develop an increasing number of severe illnesses (opportunistic infections)
• AIDS is diagnosed when CD4 cell counts drop below 200 cells/mm or if patients develop certain opportunistic infections
• People with AIDS can have a high viral load and be highly infectious
• Without treatment, the life expectancy for AIDS patients is about three years

In the U.S., patients who are diagnosed with human immunodeficiency virus (HIV) in stage 1 and who start taking antiretroviral therapy (ART) right away, life expectancy is estimated to be near to the normal life expectancy of the general population. 

Without treatment, HIV can progress to acquired immunodeficiency syndrome (AIDS). The life expectancy for AIDS patients is about three years. 

To reduce the chance of spreading the human immunodeficiency virus (HIV) to other people:

• Get tested for HIV 
  • If you test positive, begin treatment as soon as possible
• Tell all potential sexual partners you have HIV
• Use a latex condom every time you have vaginal, anal, or oral sex
• Do not share razors or toothbrushes with others
• Do not share drug needles or syringes with others