A bit about my background
I have been involved in HIV care since 2005. I was running one of the designated Anonymous HIV Testing Sites in Singapore. I am also part of the Singapore HIV PrEP Taskforce and am one of the authors of the Singapore HIV PrEP prescribing guidelines. I also am one of the authors of the Blueprint to end AIDS and HIV transmission in Singapore. I have written multiple articles on HIV for magazines and other media. And have been interviewed on the topic.
In my time as a practicing physician, I have unfortunately had to deliver bad news to some patients who have been infected with HIV. However, for the majority of patients, they are fortunately not infected but understandably worried.
After an exposure, many patients worry about their risk of getting infected with HIV. They then start to look for symptoms to determine if they have been infected with HIV or not. In this article, I will talk about the early symptoms of HIV infection. I will share both research data as well as my own experience.
Please note that this blog article only talks about the early symptoms of HIV infection. It does not talk about the symptoms of advanced HIV infection or AIDS.
First the basics – what is HIV and AIDS?
HIV is an acronym of Human Immunodeficiency Virus. After this virus infects a patient, it sets about destroying the patient’s immune system. It can take anywhere from 6 to 16 years for the HIV virus to reduce a person’s immune function to a state where the person can no longer fight off even the most simple infections. When this happens, the patient is said to have the disease AIDS or Acquired Immune Deficiency Syndrome. So yes, HIV causes AIDS.
How is HIV spread?
The most common way HIV is spread from person to person is via unprotected sexual intercourse with a person who is infected with HIV and not on any treatment. HIV can also be spread via sharing of contaminated needles most commonly seen in people who abuse intravenous drugs. There was a time that HIV was spread via contaminated donor blood or organs. But with the introduction of strict screening protocols for donor blood and organs in place these days, I have not heard of HIV spreading this way for many years. There also have been isolated reports of HIV being spread via contaminated dental and medical surgical tools.
Importantly, HIV is not spread via casual contact like hugging and kissing. It is also not spread through sharing toilets, sharing food or sharing towels. You will not catch HIV from living or working with a person living with HIV.
Click here to read my article detailing the risks and probabilities of getting HIV.
When do HIV symptoms appear?
First I have to say that not everyone who is infected with HIV will develop symptoms. In fact, up to 60% of people infected with HIV will not experience any symptoms. Next I would like to say that the early symptoms of HIV are similar to many other viral infections even influenza infections. So remember that having symptoms does not mean you are infected with HIV. Conversely, not having symptoms also does not mean you are in the clear and not infected with HIV. The only sure way to know is to get a HIV test.
That said, after a person is infected with HIV, the patient may develop a constellation of symptoms that are collectively known as Acute Retroviral Syndrome (ARS) also known as Acute HIV Syndrome.
These symptoms can appear a few days to a few weeks after infection. Usually symptoms occur 2 to 4 weeks after infection. And can last for a few days to even a few months. But usually lasts less than 14 days.
In my experience, patients who do develop ARS usually do so between 2 to 6 weeks after infection. And symptoms usually lasts 2 to 3 weeks.
What are the early symptoms of a HIV infection?
There are several possible symptoms. Not every patient will develop every symptom. Everyone will have a different combination of symptoms. The possible symptoms and the frequency in which they appear include:
- Fever – 80% to 90%
- Fatigue – 70% to 90%
- Rash – 40% to 80%
- Headache – 30% to 70%
- Swollen Lymph Nodes – 40% to 70%
- Sore Throat – 50% to 70%
- Muscle and Joint Aches – 50% to 70%
- Nausea, Vomiting or Diarrhea – 30% to 60%
- Night Sweats – 50%
- Oral Ulcers – 10% to 20%
- Genital Ulcers – 5% to 15%
Many patients ask me questions like “How high is the fever due to HIV?” “How long does the fever last for?” “What does the HIV rash look like?” “How does the sore throat due to HIV feel?” “Is it like any other sore throat?”
Because symptoms are non-specific and variable in frequency and severity, there are very few studies to detail the symptoms. This fact makes such questions impossible to answer. Because the answer is simply, it is different for everybody.
Furthermore, these symptoms are not to assist Doctors in making a diagnosis. It is for Doctors to be aware. So that if we notice such symptoms in patients, we will ask for more details on any activities that might put them at risk for HIV. If there are none, Doctors will look for a myriad of possible other diagnoses that may cause such symptoms like influenza or mononucleosis (glandular fever).
So if even Doctors cannot determine your HIV status from your symptoms, it is very likely you are also not able to. So my best advice to all my patients is to get tested regardless of the symptoms.
What do studies on early symptoms of HIV tell us?
- Patients with HIV ARS fever have a body temperature ranging from 38.0°C to 40.0°C. In one study the average temperature was 38.9°C.
- Developing enlarged lymph nodes is common. These enlarged lymph nodes are usually non-tender and develop in the neck, armpits and back of the head. They often develop 2 weeks after infection. The enlarged lymph nodes subsequently decrease in size but may not return fully to normal size.
- Sore throat is a common symptom of HIV ARS. Usually the tonsils not enlarged. But in some cases one or both tonsils can be swollen or enlarged.
- Developing ulcers is one of the most distinctive and most telling signs of an acute HIV infection. There are shallow painful ulcers with a white base surrounded by redness found in the mouth, penis and anus. However other STDs like herpes and chancroid can cause similar looking ulcers.
- The HIV ARS rash comes on 48 to 72 hours after the onset of fever. And persists for 5 to 8 days. The face, collar and upper chest are the areas most involved. Although the rash can also affect the scalp, limbs and even palms and soles. The rash is described as 5 to 10mm well-circumscribed, oval or round, pink to red spots. It is either not itchy or mildly itchy.
- HIV ARS is causes nausea, diarrhea, loss of appetite with an average weight loss of 5kg
- The headache associated with HIV ARS is described as a pain behind the eyes made worse by eye movement
My experience
The following segments detail my personal experience from diagnosing and managing patients with HIV. They are only anecdotal. Again I remind the reader that you cannot and should not use the presence or absence of symptoms to determine your HIV status. Instead you should see a Doctor and get tested.
The HIV Fever
In my experience, the HIV fever comes on between 2 to 4 weeks after infection. The body temperature (measured with an ear probe thermometer) is always above 38.5°C. The fever lasts for 2 weeks then goes away even without treatment. During which time taking Paracetamol temporarily reduces the fever but never below 37.5°C.
I have seen many worried patients that their own temperatures multiple times a day. Some even every 10 minutes. They then come to see me worried because at times, their temperature goes up to 37.5°C. I always reassure them that this is not a fever. And honestly, regardless if they have a fever or not, if they are at risk of a HIV infection, I will advise them to get tested.
The HIV rash
For the cases I have seen, the HIV rash is a blotchy red rash involving the face, neck, upper chest and arms. It gets less intense as it moves down to the abdomen and legs. It also comes on between 2 to 4 weeks after infection and usually 2 to 3 days after the onset of the fever. It remains for 2 to 3 weeks then fades away even without treatment.
For patients who do develop the HIV ARS rash, the rash is always visible enough for others to notice. Many patients I have seen are overly anxious of small isolated red or brown spots on their arms or chest. This is not how a HIV ARS rash looks like.
The HIV swollen lymph nodes
The lymph nodes I examine my patients for are mostly the cervical (neck) lymph nodes. I find that the lymph nodes are usually significantly enlarged (cherry size) and tender (uncomfortable to the touch). Also more than one lymph node will be enlarged on both sides of the neck.
In some people, especially people who are skinnier, normal sized lymph nodes can also be felt along the neck. These are not tender and about the size of a cherry seed. Very often, I see patients who feel these lymph nodes and worry unnecessarily thinking they are swollen lymph nodes. What makes it worse is because the patient constantly rubs at the lymph nodes, this actually causes the lymph node to swell and become tender. The patient then becomes even more anxious and rubs them even more. Thus leading himself down a rabbit hole of fear and anxiety.
The HIV sore throat
The sore throat I usually see in the patients I have diagnosed with HIV is usually severe. The throat is very red with many small and painful ulcers in the back of the throat. Sometimes the tonsils are enlarged with white or yellow liquid on it.
Many patients who are not infected with HIV but worried see me because they experience some discomfort in the throat. The problem is anxiety can also cause the throat to feel dry, uncomfortable or even as if something is stuck in it (globus sensation). Which then of course makes the patient more worried as “sore throat” is commonly listed as a symptom of HIV ARS.
Other symptoms of HIV ARS
Other symptoms such as headache, lethargy, joint aches and muscles aches are unfortunately much too non-specific for me to comment on. As you know, these symptoms can be caused by almost every illness or disease. In fact, these symptoms can also be caused by a hard day at the gym. So I am unable to provide much more information on them.
In conclusion.....
If you have had a high risk exposure to HIV and 2 to 4 weeks later developed:
- A fever of at least 38.5°C and
- A rash over your face and upper chest that your co-worker points out to you and
- 2 to 3 tender cherry size lymph nodes of both sides of your neck and
- A painful throat that when you look in you see is fiery red with several ulcers and
- With a combination of lethargy, headache, muscle aches and joint aches
Then go see your Doctor for a HIV test.
Remember, having all the above does not mean you are infected with HIV.
Also, if you have had a high risk exposure to HIV but feel absolutely completely well, go see your Doctor for a HIV test. Having no symptoms does not mean you are safe.
If your exposure was less than 3 days ago please see your Doctor urgently to discuss if HIV PEP is right for you.
Have a question? Type it in the comments section below and I’ll get back to you as soon as I can.