Reviewed by: HU Medical Review Board | Last reviewed: September 2019
HIV progresses in three stages: early-stage HIV, clinical latency, and late-stage HIV (also known as AIDS). Each stage has its own specific characteristics.
An individual who is newly infected with HIV may show symptoms early on, and then have no symptoms for years after, depending on how quickly their HIV progresses.
The symptoms that can occur early on are often non-specific, and easy to mistake for another illness, like the flu or another short-term virus. It’s also possible to have no early symptoms of HIV at all. In fact, about a third of individuals who are newly infected with HIV may not show any of these early flu-like symptoms.1
For those who do experience signs of early-stage HIV infection, also called acute or primary HIV infection, symptoms often include but are not limited to:1-4
- Fever (greater than 100.4ºF or 38ºC)
- Swollen lymph nodes (especially in the armpits and neck)
- Sore muscles or joints
- Sore throat
- Rash (especially across the neck, face, and upper chest)
- Dry cough
- Weight loss
Clinical latency stage
The second stage of HIV, after acute or primary infection, is called the clinical latency stage. This period may also be referred to as chronic HIV infection.
After initial infection, HIV replication eventually slows down within the body, although it never actually stops. An individual reaches a balance point during this period where HIV replication and CD4 cell death (the human immune cells that HIV infects) level off. Without treatment, this period of time can last anywhere from two to 15 years, or more, depending on a variety of factors.
As time goes on, the HIV replication will slowly win out over the CD4 cells, leading to a significant decrease in CD4 count over time. CD4 cells are cells that are part of the immune system and help our bodies fight off infections and other foreign invaders.1-5
During this stage of HIV infection, an HIV-positive individual may experience no symptoms at all. This is the case for both individuals taking ART and those not taking ART (medications used to treat HIV and prevent its progression). During clinical latency, an HIV-positive individual may have no idea that they have the virus, even though it is very slowly destroying their immune system. This is an example of why HIV testing is important for those who may be at risk, even if they don’t feel sick.
The most advanced stage of HIV is AIDS (acquired immunodeficiency syndrome). Eventually, the slowly replicating HIV in a person’s body will lead to a significant decrease in their CD4 cell count. A normal CD4 count in a healthy individual can be anywhere from 500-1,500 cells/microliter. When an individual has AIDS, their CD4 count is below 200 cells/microliter (also referred to as a CD4 count of 200). When an individual’s CD4 count gets very low, such as below 50, their HIV is thought to be very advanced.3
Without CD4 cells, we are much more susceptible to illnesses, foreign invaders, and cancers. One thing that is of particular importance for individuals with late-stage HIV are opportunistic infections. An opportunistic infection is one that normally wouldn’t affect an individual with a healthy immune system, but can greatly affect someone with HIV. These infections can take over our bodies and be potentially life-threatening.1-5
The symptoms of these infections, and other issues related to a weakened immune system, are the symptoms often associated with AIDS. Several of these include, but are not limited to:1-5
- Recurring fever
- Extreme tiredness
- Rapid weight loss
- Recurring night sweats
- Long-term diarrhea
- Persistent cough
- Long-term swelling of lymph nodes in the neck, groin, or armpits
- Neurological issues such as depression or memory loss
- Sores in or around the mouth, genitals, or anus
- Purple, brown, red, or pink blotches inside the mouth or nose, under or on the skin, or around the eyelids
Regardless of an individual’s CD4 count, they can be diagnosed with AIDS at any time if they have HIV and one or more AIDS-defining illnesses, including invasive cervical cancer, Burkitt lymphoma, and many others.3 The median survival for someone diagnosed with AIDS is about 12 months to three years if the individual is not taking any medications, however, this can be significantly extended with regular treatment with ART.1-5