HIV symptoms vary by the stage of infection, known as primary infection (Stage 1), clinical latency (Stage 2), and AIDS (Stage 3).
During primary infection, the symptoms are caused by the virus itself, leading to fever, fatigue, and swollen lymph nodes. During the later stages, symptoms are more often the result of opportunistic infections that occur when the virus progressively destroys the immune system and leaves it vulnerable to diseases that can affect the skin, lungs, eyes, brain, and other organs.
Verywell / Colleen Tighe
HIV Among Black People in the U.S.
HIV disproportionately affects people of color in the United States. Because they are less likely to receive HIV-specific care, Black people with HIV are at a seven-fold greater risk of death than White people with HIV. This is despite the fact that Black people are no less likely to be diagnosed during later-stage infections than White people.
Stage 1 Symptoms: Primary Infection
Primary infection occurs when HIV enters the body and the immune system is activated to fight the virus. Also known as acute seroconversion, this is the stage where the body tries to control the infection.
During primary infection, the immune system will defend itself by releasing chemicals that cause inflammation. While this helps the body defend itself, it can cause symptoms similar to the flu as the brain, skin, muscles, joints, and respiratory tract are subject to intense inflammation.
Symptoms during this stage may include:
One in five people will also develop an “HIV rash” characterized by raised, reddened areas of skin covered with pimple-like bumps. The rash mostly affects the upper body and may be accompanied by mouth or genital ulcers.
Not everyone who gets HIV develops symptoms during primary infection. Those who do generally do so within two to four weeks of exposure.
Primary infection can last for around two to four weeks, after which symptoms will clear as the immune system brings the infection under control. However, the virus is not gone but instead starts to hide itself in tissues (called latent reservoirs) throughout the body.
Early symptoms like these don’t necessarily mean you have HIV. But if you are sexually active and have risk factors for HIV (including condomless sex, multiple sex partners, or being a man who has sex with men), you should get tested.
HIV Among Black MSM and Trans People
Black people and men who have sex with men (MSM) account for the lion’s share of new HIV infections in the United States. Roughly 30% of all new cases are among Black MSM who have no less than a 50/50 chance of getting HIV in their lifetime. Black transgender people are also at risk, particularly Black trans women of whom 62% are living with HIV.
Causes for this disparity include stigma, racism, higher rates of poverty, and lack of access to quality healthcare. These may not only discourage a person from seeking diagnosis and treatment but also account for higher rates of HIV-associated illness and death in Black populations.
Stage 2 Symptoms: Clinical Latency
Clinical latency, also known as chronic HIV infection, occurs when the initial symptoms have cleared, but the infection persists at lower levels in the blood. During this prolonged secondary stage, the virus is still contagious even if a person is asymptomatic (without symptoms).
Without treatment, chronic HIV infection usually progresses to AIDS within 10 years or more. For some people, clinical latency may be as short as two years. Genetics, lifestyle, general health, and a lack of access to quality healthcare can contribute to faster disease progression.
During clinical latency, the virus is able to persist by hiding in latent reservoirs. Those in circulation will continue to target and kill white blood cells called CD4 T-cells that direct the immune assault.
As more and more of these cells are destroyed, the CD4 count (which measures the number of CD4 T-cells in your blood) can drop beneath normal levels of 500 to 1,500, leaving the body less able to recognize and fight infections.
During clinical latency, a person may experience non-specific symptoms like:
Certain opportunistic infections (OIs)—meaning infections that the body can usually control when the immune system is intact—can also start to appear. Some of the more common include viral infections like genital herpes and shingles.
With treatment in the form of antiretroviral drugs, people can remain in this stage indefinitely and never progress. The drugs can also help normalize the CD4 count, reducing your risk of OIs.
Verywell / Julie Bang
HIV and Poverty in Black and Latinx Communities
According to research from Emory University, the rate of poverty among people living with HIV in urban Latinx communities is about two times greater than their White counterparts. For Black communities, it is about seven times greater. This translates to faster disease progression and poorer survival times in people of color.
Stage 3 Symptoms: AIDS
AIDS (acquired immune deficiency syndrome) is the most advanced stage of HIV where the body’s immune defenses have been fully breached. This leaves you vulnerable to an ever-widening range of severe and even life-threatening OIs.
An AIDS diagnosis is less common today due to the widespread use of antiretroviral drugs. The risk of AIDS is greater in those with a lack of access to healthcare or who avoid testing due to stigma or the fear of discrimination or illness.
AIDS is defined by the Centers for Disease Control and Prevention (CDC) as having either:
Symptoms at this stage are primarily related to the type of OI a person gets. There are a handful of exceptions, such as AIDS dementia and HIV wasting syndrome, both of which are thought to be caused by the virus.
The symptoms of AIDS can be characterized by the organ systems affected by the AIDS-defining condition:
| Organ System | Possible Symptoms |
|---|---|
| Brain | Painful headaches, muscle weakness, numbness or nerve pain, loss of coordination and clumsiness, difficulty walking, hearing impairment, changes in vision, difficulty swallowing, confusion, changes in behavior, seizures, dementia |
| Eyes | Persistent eye dryness, decreased vision, extreme sensitivity to light. matting or whitening of the cornea, vision loss, blindness |
| Gastrointestinal | Mouth and throat sores, whitish growth in the mouth or throat, severe abdominal pain, lower abdominal swelling, bloating and gas, difficulty swallowing, painful swallowing, nausea and vomiting, diarrhea, constipation, blood in stool, bloody vomit, black or tarry stool, rectal pain, unintended weight loss |
| Liver | Upper abdominal pain, extreme fatigue, loss of appetite, nausea or vomiting, clay-colored stool, cola-colored urine, ascites (fluid buildup in the abdomen), jaundice (yellowing of eyes and skin) |
| Lungs | Shortness of breath, wheezing, chronic cough, phlegm, difficulty breathing, chest pain, easy exhaustion with physical activity, crackling lung sounds, pneumonia |
| Skin | Painless bruise-like lesions, an outbreak of painful blisters and ulcers, shole-body rash, hardened or crusty skin plaques, pus-filled skin eruptions, nail deformity, cellulitis and other skin infections |
As with any other stage of HIV, you can still pass the virus to others. But by getting treatment and suppressing the virus to undetectable levels, you can reduce the risk of transmission by up to 99% (a strategy commonly known as HIV PrEP). This is true irrespective of your stage of infection.
AIDS Diagnoses Among Black People
Due to health inequities and other vulnerabilities, Black people with HIV are more than 10 times more likely to progress to AIDS than White people with HIV and three times more likely than Latinx people with HIV.
How to Know if You Have HIV
Because the symptoms of HIV are often non-specific (or non-existent), it can be hard to tell if you have HIV by symptoms alone.
Because many of the earlier symptoms are easily missed or attributed to other less serious causes, a person may only realize they have HIV whether they develop a serious OI like tuberculosis or a rare AIDS-defining illness like mycobacterium avium complex (MAC).
The problem with this it is far harder to rebuild the immune system when treatment is started at CD4 counts below 200. When the CD4 count is below 100 or 50, a person may never reach normal levels even with treatment.
To this end, it is important to get tested if you have risk factors for HIV whether you have symptoms or not. These include:
Based on these risk factors, the U.S. Preventive Services Task Force (USPSTF) recommends once-off HIV testing for all people between the ages of 15 and 65 as part of a routine healthcare visit. The CDC similarly endorses once-off testing between the ages of 13 and 64.
For people at ongoing risk—such as sexually active men who have sex with men, people with multiple sex partners, and injecting drug users—routine HIV testing is recommended.
Summary
HIV has three three stages: primary, clinical latency, and AIDS. People in the primary stage may experience flu-like symptoms between two and four weeks after exposure. People in the latent stage (which can last 10 years or more) may experience persistent fatigue, swollen lymph nodes, and recurrent respiratory infections.
When HIV progresses to AIDS, symptoms can vary based on the type of opportunistic infections a person gets. Treatment with antiretroviral drugs can restore the immune system and should be started at any stage of infection.
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